Provider Demographics
NPI:1174596290
Name:CALLARI, RICHARD H (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:CALLARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:415 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1901
Mailing Address - Country:US
Mailing Address - Phone:954-760-7836
Mailing Address - Fax:954-760-7869
Practice Address - Street 1:415 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1901
Practice Address - Country:US
Practice Address - Phone:954-760-7836
Practice Address - Fax:954-760-7869
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56677207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063498100Medicaid
FLE56530Medicare UPIN
FLE56530Medicare UPIN