Provider Demographics
NPI:1972574028
Name:ATWELL, CALVIN E (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:E
Last Name:ATWELL
Suffix:
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 1:870 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7159
Mailing Address - Country:US
Mailing Address - Phone:309-281-6400
Mailing Address - Fax:309-281-6409
Practice Address - Street 1:870 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7159
Practice Address - Country:US
Practice Address - Phone:309-281-6400
Practice Address - Fax:309-281-6409
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079520208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1891740882OtherMMSA NPI #
IA3237461Medicaid
IL1891740882OtherMMSA NPI #
IA3237461Medicaid
ILK27905Medicare PIN
IAI12494Medicare PIN