Provider Demographics
NPI:1497746903
Name:MONROE, CALVIN PEITREI (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:PEITREI
Last Name:MONROE
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:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:441 W HAY ST FL 1
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6324
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01095436A207V00000X
OK24674207V00000X
IL036.111520207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768880FMedicaid
OK100768880IMedicaid
OK37-1834OtherMEDICARE
OK100768880JMedicaid
OK200067100AMedicaid
OK100768880FMedicaid
OK37-1834OtherMEDICARE
OK100768880FMedicaid
OK37-1834OtherMEDICARE
OK200067100AMedicaid
OK200067100AMedicaid