Provider Demographics
NPI:1306944673
Name:CALDWELL, ESLY II (MD)
Entity type:Individual
Prefix:DR
First Name:ESLY
Middle Name:
Last Name:CALDWELL
Suffix:II
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 1:2215 UPLAND PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2212
Mailing Address - Country:US
Mailing Address - Phone:513-861-1354
Mailing Address - Fax:
Practice Address - Street 1:2215 UPLAND PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2212
Practice Address - Country:US
Practice Address - Phone:513-861-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042906C207R00000X
KY23202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0385677Medicaid
KY64028244Medicaid
KY1400802Medicare ID - Type Unspecified
OHCA0487651Medicare ID - Type Unspecified
KY64028244Medicaid