Provider Demographics
NPI:1194544684
Name:CALHOUN, DEVONTAE JAMAAL
Entity type:Individual
Prefix:
First Name:DEVONTAE
Middle Name:JAMAAL
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 ZACHARY LN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-0005
Mailing Address - Country:US
Mailing Address - Phone:317-937-5614
Mailing Address - Fax:
Practice Address - Street 1:4249 ZACHARY LN
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46062-0005
Practice Address - Country:US
Practice Address - Phone:317-937-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN45022543A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program