Individual
CALLEY A. LIDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
233 GRAND AVENUE, ST. PAUL, MN 55102-9658
(651) 227-7806
(651) 256-6707
Mailing address
233 GRAND AVENUE, ST. PAUL, MN 55102-9658
(651) 227-7806
(651) 256-6707
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125050402
IL
208000000X
Pediatrics Physician
Primary
51175
MN
208000000X
Pediatrics Physician
52074-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185153436
—
MN
Enumeration date
05/03/2007
Last updated
07/02/2009
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