Healthcare Provider Details

I. General information

NPI: 1366604894
Provider Name (Legal Business Name): ELIZABETH ANNE CALLAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

IV. Provider business mailing address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-4900
  • Fax: 734-547-4901
Mailing address:
  • Phone: 734-547-4900
  • Fax: 734-547-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005201
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: