Provider Demographics
NPI:1871532366
Name:CALLEJA, DAN E (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:E
Last Name:CALLEJA
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 1:100 STERLING WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1176
Mailing Address - Country:US
Mailing Address - Phone:859-498-0200
Mailing Address - Fax:859-498-5812
Practice Address - Street 1:100 STERLING WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1176
Practice Address - Country:US
Practice Address - Phone:859-498-0200
Practice Address - Fax:859-498-5812
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40772208M00000X, 207R00000X, 207RP1001X
FLME0084183207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11530750OtherCAQH ID NO.
KY37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KY7100023090Medicaid
FL268023800Medicaid
KY11530750OtherCAQH ID NO.
FL268023800Medicaid
KY4000501OtherMEDICARE LAB GROUP