Healthcare Provider Details

I. General information

NPI: 1235973157
Provider Name (Legal Business Name): KYLE M CALLAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 NAAB RD
INDIANAPOLIS IN
46260-1972
US

IV. Provider business mailing address

8414 NAAB RD
INDIANAPOLIS IN
46260-1972
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6399
  • Fax: 317-231-5405
Mailing address:
  • Phone: 317-338-6399
  • Fax: 317-231-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11024876A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: