Healthcare Provider Details

I. General information

NPI: 1871665711
Provider Name (Legal Business Name): WILLIAM A CALLAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 DREW AVE S
EDINA MN
55435
US

IV. Provider business mailing address

6525 DREW AVE S
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-6778
  • Fax: 952-920-3863
Mailing address:
  • Phone: 952-920-6778
  • Fax: 952-920-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number23237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: