Provider Demographics
NPI:1154290039
Name:CALLE, MATTHEW FELIP (MT-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:FELIP
Last Name:CALLE
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22124 SW 88TH CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1211
Mailing Address - Country:US
Mailing Address - Phone:786-266-4010
Mailing Address - Fax:
Practice Address - Street 1:22124 SW 88TH CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1211
Practice Address - Country:US
Practice Address - Phone:786-266-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty