Provider Demographics
NPI:1043312051
Name:CALLENTINE, VERLAINNA CATHLEEN-SHAW (MD, MED)
Entity type:Individual
Prefix:DR
First Name:VERLAINNA
Middle Name:CATHLEEN-SHAW
Last Name:CALLENTINE
Suffix:
Gender:F
Credentials:MD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22660 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7379
Mailing Address - Country:US
Mailing Address - Phone:815-439-0512
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36104536Medicaid
ILH56645Medicare UPIN
ILK05322Medicare ID - Type Unspecified