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NPI Code Detail

MEDICARE: DR. TIMOTHY GERARD O CALLAGHAN DO

MEDICARE: DR. TIMOTHY GERARD O CALLAGHAN DO
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 Physician009392MI

General Provider Information

NPI Number : 1982604617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY GERARD O CALLAGHAN DO
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number : 231-843-8499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 09/05/2014

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