Provider Demographics
NPI:1669349544
Name:CALHOUN, ANDRE MAURICE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:MAURICE
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 1:1939 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3959
Mailing Address - Country:US
Mailing Address - Phone:440-963-7042
Mailing Address - Fax:440-963-9248
Practice Address - Street 1:1939 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3959
Practice Address - Country:US
Practice Address - Phone:440-963-7042
Practice Address - Fax:440-963-9248
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006993175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty