Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 019031599 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 036147058 | IL |
NPI | 1083920227 |
---|---|
Provider Name | Dr. Nicholas Callahan |
First Address | Chicago, IL 60612-7210 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 03/01/2020 |