Provider Demographics
NPI:1689066326
Name:RICARDO O. CALONGE, MD PA
Entity Type:Organization
Organization Name:RICARDO O. CALONGE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:O
Authorized Official - Last Name:CALONGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-9771
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-856-9771
Mailing Address - Fax:305-728-0536
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-856-9771
Practice Address - Fax:305-728-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID330AMedicare PIN