Healthcare Provider Details

I. General information

NPI: 1205236973
Provider Name (Legal Business Name): DAVID HARLEY MCCALLUM N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 KING RD STE A
RIVERVIEW MI
48193-7909
US

IV. Provider business mailing address

14700 KING RD STE A
RIVERVIEW MI
48193-7909
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-1944
  • Fax:
Mailing address:
  • Phone: 734-479-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number4704236050
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704236050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: