Individual
LYLE T. CALCAMUGGIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11311 BRIDGEPORT WAY SW, STE 302, LAKEWOOD, WA 98499-3071
(253) 985-2920
(253) 985-6812
Mailing address
11311 BRIDGEPORT WAY SW, STE 302, LAKEWOOD, WA 98499-3071
(253) 985-2920
(253) 985-6812
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
35060887
OH
207V00000X
Obstetrics & Gynecology Physician
Primary
MD60209694
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000244956
ANTHEM
OH
01
—
01981
PARAMOUNT
OH
01
—
0301634
STATE L&I
WA
05
—
0933986
—
OH
01
—
13-50420
UHC
OH
01
—
160060036
RRMC
OH
01
—
4557213
AETNA
OH
Enumeration date
07/26/2005
Last updated
10/13/2015
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