Healthcare Provider Details

I. General information

NPI: 1659783934
Provider Name (Legal Business Name): NICHOLAS KNOBLE CALLAHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ALLEN BRADLEY DR STE 200
MAYFIELD HEIGHTS OH
44124-6130
US

IV. Provider business mailing address

300 ALLEN BRADLEY DR STE 200
MAYFIELD HEIGHTS OH
44124-6130
US

V. Phone/Fax

Practice location:
  • Phone: 844-746-8537
  • Fax: 216-313-9166
Mailing address:
  • Phone: 844-746-8537
  • Fax: 216-313-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.014321
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: