Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 01053762A | IN |
NPI | 1548396492 |
---|---|
Provider Name | Michael Callahan |
First Address | Indianapolis, IN 46260-1316 |
Second Address | Indianapolis, IN 46260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 15/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H80215 | (02) |