Healthcare Provider Details

I. General information

NPI: 1477548808
Provider Name (Legal Business Name): ELIZABETH F CALLAHAN M.D., LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7978 COOPER CREEK BLVD SUITE 204
UNIVERSITY PARK FL
34201-2141
US

IV. Provider business mailing address

7978 COOPER CREEK BLVD SUITE 204
UNIVERSITY PARK FL
34201-2141
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:
Title or Position:
Credential:
Phone: