Provider Demographics
NPI:1972620912
Name:HSU, CALISTE IV (MD)
Entity Type:Individual
Prefix:DR
First Name:CALISTE
Middle Name:IV
Last Name:HSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CALISTE
Other - Middle Name:NY
Other - Last Name:IV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 EDMUNDSON PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4619
Mailing Address - Country:US
Mailing Address - Phone:712-323-5333
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:1 EDMUNDSON PL
Practice Address - Street 2:SUITE 500
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4619
Practice Address - Country:US
Practice Address - Phone:712-323-5333
Practice Address - Fax:712-323-3252
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39983208600000X, 2086S0105X
NE26587208600000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099614002Medicare PIN
IA096020004Medicare PIN