Mikel Calderon, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9109411 Issued in FL

Practice address

2307 W Broward Blvd
Ste 200
Fort Lauderdale, FL 33312-1417

Phone

(954) 792-1010

Fax

(954) 792-1199

NPI assigned

Dec 23, 2008

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Specialtycare Surgical Assist, LLC

  • Surgical Physician Assistant
  • Boynton Beach, FL
  • NPI 1740395748
  Medicare reassignment
• La Libertad Medical Clinic Inc

  • General Practice Physician
  • South Gate, CA
  • NPI 1073791828
  NPD (past)
• La Libertad Medical Clinic Inc.

  • General Practice Physician
  • Walnut Park, CA
  • NPI 1861882946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1154567063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 W BROWARD BLVD",
            "address_2": "STE 200",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121417",
            "telephone_number": "954-792-1010",
            "fax_number": "954-792-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2307 W BROWARD BLVD",
            "address_2": "STE 200",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121417",
            "telephone_number": "954-792-1010",
            "fax_number": "954-792-1199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1926 10th Ave N Ste 105",
            "address_purpose": "LOCATION",
            "city": "Lake Worth",
            "state": "FL",
            "postal_code": "334613300",
            "country_code": "US",
            "telephone_number": "615-345-5400",
            "fax_number": "888-468-6511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALDERON",
        "first_name": "MIKEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9109411",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "BO758W",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Calcano, P.A.
• Allison Calderbank
• Paul Calderin, LPN, AA
• Marisol Calderon, PHARMD
• Michelle Calderon, BCBA
• Rodin Calderon, BA, CRPS
• George L Caldwell, MD
• Nicole Tiquana Caldwell, C.N.A./P.C.T./M.H.T.
• Maria Jose Calero, MD
• Paul Calise, MD

• Surgical Physician Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.