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General NPI Number Information
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NPI Number | 1114020641
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Entity Type | Organization
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Legal Business Name | GERIATRIC & GENERAL PSYCHIATRY
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 6525 DREW AVE S
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-920-6748
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Fax | 952-920-3863
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Provider Business Mailing Address
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Address Line | 6525 DREW AVE S
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-920-6748
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Fax | 952-920-3863
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM CALLAHAN
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Credential | MD
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Telephone | 952-920-6748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 23237
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License Number State | MN
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