Provider Demographics
NPI:1245529858
Name:CALLE, INGRID MARIE (DO)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:MARIE
Last Name:CALLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:MARIE
Other - Last Name:RACHINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:316 E BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 E BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4710
Practice Address - Country:US
Practice Address - Phone:406-585-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60463760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine