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General NPI Number Information
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NPI Number | 1588751143
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Entity Type | Individual
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Provider Name | CHARLES X MCCALLA MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 550 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3239
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Country | US
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Telephone | 812-355-3688
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Fax | 812-355-3656
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Provider Business Mailing Address
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Address Line | 9000 NEWANNA LN
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City | NASHVILLE
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State | IN
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Zip | 47448-8021
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Country | US
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Telephone | 812-988-4318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01028978A
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License Number State | IN
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