Provider Demographics
NPI:1396304788
Name:CALDERON, KARINA MARIEL (PA-C)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:MARIEL
Last Name:CALDERON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:909 W BUENA AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1693
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 S MAPLE AVE STE 3700
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2806
Practice Address - Country:US
Practice Address - Phone:708-660-6430
Practice Address - Fax:708-660-6447
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.007044363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant