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NPI Code Detail

MEDICARE: BERT C CALLAHAN MD

MEDICARE: BERT C CALLAHAN 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
1207X00000XOrthopaedic Surgery Physician29788WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760573927
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERT C CALLAHAN MD
Provider Business Mailing Address
First Line : 420 E DIVISION ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-4560
Country : US
Telephone Number : 920-926-8340
Fax Number : 920-926-8370
Provider Business Practice Location Address
First Line : 608 W BROWN ST
Second Line :
City : WAUPUN
State : WI
Zip : 53963-1788
Country : US
Telephone Number : 920-324-6802
Fax Number : 920-324-8428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 01/05/2021

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Directions to “ BERT C CALLAHAN MD” Practice Location

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