Basic Information
| Provider Information | |||||||||
| NPI: | 1013178508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALCAGNO | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 560825 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802560825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195957580 | ||||||||
| FaxNumber: | 7195450176 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N. GRAND AVE. | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195622001 | ||||||||
| FaxNumber: | 7195622742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS015013 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | OS015013 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208D00000X | OS015013 | PA | N | Allopathic & Osteopathic Physicians | General Practice | 207RG0100X | DR.0062270 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 9000173652 | 05 | CO | MEDICAID |