Provider Demographics
NPI:1508353749
Name:STREETER, CALVIN II (DO)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:STREETER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7832 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9002
Mailing Address - Country:US
Mailing Address - Phone:574-360-8513
Mailing Address - Fax:
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-5084
Practice Address - Fax:303-847-0211
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program