Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 55953 | MN |
Y | 2080P0208X | Pediatric Infectious Diseases | 55953 | MN |
NPI | 1538330980 |
---|---|
Provider Name | Shane Cameron Mcallister |
First Address | Minneapolis, MN 55454-1404 |
Second Address | Minneapolis, MN 55454-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2008 |
Last Update Date | 02/10/2017 |