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NPI Code Detail

MEDICARE: CHARLES L MACCALLUM MD

MEDICARE:   CHARLES L MACCALLUM  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35040856MOH

General Provider Information

NPI Number : 1295728475
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES L MACCALLUM MD
Provider Business Mailing Address
First Line : 5778 DARROW RD STE 201
Second Line :
City : HUDSON
State : OH
Zip : 44236-3808
Country : US
Telephone Number : 330-655-2161
Fax Number : 330-650-2116
Provider Business Practice Location Address
First Line : 5778 DARROW RD
Second Line : SUITE D
City : HUDSON
State : OH
Zip : 44236-3808
Country : US
Telephone Number : 330-655-2161
Fax Number : 330-650-2116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 12/22/2020

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Directions to “ CHARLES L MACCALLUM MD” Practice Location

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