Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 01071025A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 38062 | IA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | ME97069 | FL |
NPI | 1003018250 |
---|---|
Provider Name | Dr. Domenico Calcaterra |
First Address | Bradenton, FL 34208-5624 |
Second Address | Indianapolis, IN 46202-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201080180 | (05) | IN |