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General NPI Number Information
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NPI Number | 1649161977
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Entity Type | Organization
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Legal Business Name | ACTAMD PLLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3425 BAYSIDE LAKES BLVD SE # 10310114
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City | PALM BAY
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State | FL
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Zip | 32909-6867
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Country | US
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Telephone | 385-229-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 10281 BENTLEY OAKS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89135-2037
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Country | US
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Telephone | 509-679-2668
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD CALLAHAN III
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Credential | MD
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Telephone | 509-679-2668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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