Provider Demographics
NPI:1720288236
Name:CALIPJO, HEIDI C (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:C
Last Name:CALIPJO
Suffix:
Gender:F
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:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1057 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3000
Practice Address - Country:US
Practice Address - Phone:573-302-3100
Practice Address - Fax:573-348-8279
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-052442207Q00000X
MO2010024506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00867670OtherRAIL ROAD MEDICARE
MO135570025OtherMEDICARE PTAN
MO1720288236Medicaid
MO2010024506OtherMO LICENSE