Emanuel Calderon, P.T.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

5501009083 Issued in MI

Practice address

1717 E Michigan Ave
Suite a
Lansing, MI 48912-2840

Phone

(517) 253-8360

NPI assigned

Jul 1, 2014

Reactivated

Feb 13, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1497161285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 E MICHIGAN AVE",
            "address_2": "SUITE A",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489122840",
            "telephone_number": "517-253-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 E MICHIGAN AVE",
            "address_2": "SUITE A",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489122840",
            "telephone_number": "517-253-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDERON",
        "first_name": "EMANUEL",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "deactivation_date": "2015-05-19",
        "reactivation_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5501009083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Lansing, MI
• Providers in Lansing, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.