Healthcare Provider Details

I. General information

NPI: 1528262136
Provider Name (Legal Business Name): THOMAS ELDON CALLAHAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

IV. Provider business mailing address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-4440
  • Fax: 563-584-4427
Mailing address:
  • Phone: 563-584-4100
  • Fax: 563-584-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4069
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: