Provider Demographics
NPI:1245861871
Name:MCCALIB, MICHAEL JORDAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JORDAN
Last Name:MCCALIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 REINLI ST APT 143
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1509
Mailing Address - Country:US
Mailing Address - Phone:832-244-6576
Mailing Address - Fax:
Practice Address - Street 1:909 REINLI ST APT 143
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1509
Practice Address - Country:US
Practice Address - Phone:832-244-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program