Provider Demographics
NPI:1790713436
Name:CALUSIC, ADAM PETER (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PETER
Last Name:CALUSIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1700
Mailing Address - Country:US
Mailing Address - Phone:262-375-3700
Mailing Address - Fax:262-375-6306
Practice Address - Street 1:215 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024
Practice Address - Country:US
Practice Address - Phone:262-375-3700
Practice Address - Fax:262-375-6306
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
O002395OtherGATEWAY
PA0006805790004Medicaid
WI100061643Medicaid
50051256OtherBLUE CROSS
PA000161435OtherHIGHMARK BLUE SHIELD
P00258005OtherRR MEDICARE
0038505000OtherBLUE SHIELD
PA4663112OtherAETNA
PA4663112OtherAETNA