Provider Demographics
NPI:1649432485
Name:KILCREASE, CALVIN DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:DEAN
Last Name:KILCREASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 REDWOOD HWY
Mailing Address - Street 2:SPACE C-14
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2427
Mailing Address - Country:US
Mailing Address - Phone:559-907-1652
Mailing Address - Fax:
Practice Address - Street 1:2130 REDWOOD HWY
Practice Address - Street 2:SPACE C-14
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2427
Practice Address - Country:US
Practice Address - Phone:559-907-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA739372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH45803Medicare UPIN