Healthcare Provider Details

I. General information

NPI: 1649161977
Provider Name (Legal Business Name): ACTAMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BAYSIDE LAKES BLVD SE # 10310114
PALM BAY FL
32909-6867
US

IV. Provider business mailing address

10281 BENTLEY OAKS AVE
LAS VEGAS NV
89135-2037
US

V. Phone/Fax

Practice location:
  • Phone: 385-229-9889
  • Fax:
Mailing address:
  • Phone: 509-679-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD CALLAHAN III
Title or Position: PRESIDENT
Credential: MD
Phone: 509-679-2668