Healthcare Provider Details

I. General information

NPI: 1336521673
Provider Name (Legal Business Name): CALLMAN INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21281 GRAYTON TER D JACOBSON VA NH
PORT CHARLOTTE FL
33954-3109
US

IV. Provider business mailing address

PO BOX 495009
PORT CHARLOTTE FL
33949-5009
US

V. Phone/Fax

Practice location:
  • Phone: 941-206-5200
  • Fax:
Mailing address:
  • Phone: 941-206-5200
  • Fax: 941-206-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME38329
License Number StateFL

VIII. Authorized Official

Name: DR. MARK L CALLMAN
Title or Position: OWNER
Credential: MD
Phone: 941-206-5200