Individual
HEIDI C CALIPJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1057 MEDICAL PARK DR, SUITE A, OSAGE BEACH, MO 65065-3000
(573) 302-3100
(573) 348-8279
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125-052442
IL
207Q00000X
Family Medicine Physician
Primary
2010024506
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135570025
MEDICARE PTAN
MO
05
—
1720288236
—
MO
01
—
2010024506
MO LICENSE
MO
01
—
P00867670
RAIL ROAD MEDICARE
MO
Enumeration date
07/23/2007
Last updated
03/07/2012
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