Provider Demographics
NPI:1043269301
Name:CALHOUN, JASON HAROLD (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:HAROLD
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:IRVING
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE 305
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8292
Practice Address - Country:US
Practice Address - Phone:616-267-8860
Practice Address - Fax:616-267-8442
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093031207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208414409Medicaid
MOP00427287Medicare PIN
MOP00277068Medicare PIN
MIM74460911Medicare PIN
C14084Medicare UPIN
MO920911112Medicare PIN
MO920915236Medicare PIN