Provider Demographics
NPI:1972567113
Name:CALADO, JOHN BENEDICT (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENEDICT
Last Name:CALADO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1639 E BIG BEAVER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2054
Mailing Address - Country:US
Mailing Address - Phone:248-606-4190
Mailing Address - Fax:248-598-5088
Practice Address - Street 1:1639 E BIG BEAVER RD STE 202
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-606-4190
Practice Address - Fax:248-598-5088
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4085015Medicaid
MIMI9716OtherMEDICARE ID TYPE NONSPECIFIC
MI4085015Medicaid
MI383440844OtherTAX ID