Healthcare Provider Details

I. General information

NPI: 1255580593
Provider Name (Legal Business Name): DANIEL CHOYCE CALLAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N SECTION ST
SULLIVAN IN
47882-7518
US

IV. Provider business mailing address

PO BOX 10
SULLIVAN IN
47882-0010
US

V. Phone/Fax

Practice location:
  • Phone: 812-268-2556
  • Fax:
Mailing address:
  • Phone: 812-268-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number4301099722
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number01080614A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number036.147496
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: