Individual
REYNALDO MARTIN CALUAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
(219) 763-8112
(219) 962-1580
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01050338A
IN
207Q00000X
Family Medicine Physician
036-096640
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096640
—
IL
01
—
1617286
BLUE CROSS BLUE SHIELD
IL
01
—
191360021
MEDICARE PTAN
IN
05
—
300000266
—
IN
Enumeration date
01/30/2007
Last updated
08/14/2020
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