Provider Demographics
NPI:1851339535
Name:CALLMAN AND VALENTE M D S PA
Entity Type:Organization
Organization Name:CALLMAN AND VALENTE M D S PA
Other - Org Name:PREMIER MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:941-629-5757
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:#104
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-629-5757
Mailing Address - Fax:941-629-7404
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:#104
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-629-5757
Practice Address - Fax:941-629-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K0078Medicare ID - Type Unspecified