Healthcare Provider Details

I. General information

NPI: 1376576454
Provider Name (Legal Business Name): ELIZABETH F. CALLAHAN, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 N HONORE AVE SUITE 210
SARASOTA FL
34243-2606
US

IV. Provider business mailing address

5911 N HONORE AVE SUITE 210
SARASOTA FL
34243-2606
US

V. Phone/Fax

Practice location:
  • Phone: 941-308-7546
  • Fax: 941-308-7550
Mailing address:
  • Phone: 941-308-7546
  • Fax: 941-308-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME89181
License Number StateFL

VIII. Authorized Official

Name: MR. TOM SIDGMORE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 941-308-7546