Provider Demographics
NPI:1881889103
Name:CALABRESE, DANIEL ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANTHONY
Last Name:CALABRESE
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:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-662-0406
Mailing Address - Fax:
Practice Address - Street 1:1896 E. BABBIT LANE
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349-1669
Practice Address - Country:US
Practice Address - Phone:928-722-6112
Practice Address - Fax:928-722-6113
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ379022080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324722Medicaid
AZZ156217OtherMEDICARE PTAN
AZ324722Medicaid