Provider Demographics
NPI:1184727539
Name:MEINEKE, CALVIN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:THOMAS
Last Name:MEINEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LAKE ST
Mailing Address - Street 2:STE LL40
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-383-7776
Mailing Address - Fax:708-383-5249
Practice Address - Street 1:1100 LAKE ST
Practice Address - Street 2:STE LL40
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-383-7776
Practice Address - Fax:708-383-5249
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03606488601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
363386229OtherCIGNA
363386229OtherALLIED
363386229OtherGOLDEN RULE
363386229OtherTRUSTMARK
4491453OtherAETNA
IL064886OtherMUTUAL OF OMAHA
110012154OtherRRMDC
31601138OtherBCBS
363386229OtherBEECHSTREET
363386229OtherUNITEDHEALTHCARE
98985OtherWELLMARK BCBS
363386229OtherFIRST HEALTH
363386229OtherHUMANA
PR2994187OtherCIGNA
363386229OtherILLINOIS PUBLIC AID
363386229OtherCORESOURCE
363386229OtherGALLAGHER BASSETT
363386229OtherTIME
363386229OtherGOLDEN RULE
98985OtherWELLMARK BCBS