Provider Demographics
NPI:1396790317
Name:CALO, COLENE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:COLENE
Middle Name:MARIE
Last Name:CALO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5070
Mailing Address - Fax:704-316-5075
Practice Address - Street 1:9604 HOLLY POINT DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4913
Practice Address - Country:US
Practice Address - Phone:704-316-5070
Practice Address - Fax:704-316-5075
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13448207N00000X
MI5101012868207NS0135X
NC2018-02899207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5500270OtherBLUE CROSS BLUE SHIELD MI
MIH04371Medicare UPIN
MI0P06850Medicare ID - Type Unspecified