Provider Demographics
NPI:1386056307
Name:CALERO, BANIA GABRIELA (MD)
Entity type:Individual
Prefix:
First Name:BANIA
Middle Name:GABRIELA
Last Name:CALERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N WESTERN AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1774
Mailing Address - Country:US
Mailing Address - Phone:312-633-5841
Mailing Address - Fax:
Practice Address - Street 1:1301 SIGMAN RD NE STE 230
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3819
Practice Address - Country:US
Practice Address - Phone:678-609-4912
Practice Address - Fax:678-609-4932
Is Sole Proprietor?:No
Enumeration Date:2014-05-25
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine