MEDICARE: DR. ROBERT EDWARD MCCALLISTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	01030428	IN
2	207NS0135X	Procedural Dermatology Physician	01030428	IN
3	207NP0225X	Pediatric Dermatology Physician	01030428	IN
4	207ND0900X	Dermatopathology Physician	01030428	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070001836	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000087049	OTHER	IN	ANTHEM PROVIDER NUMBER
2	351711573	OTHER	IN	TAX IDENTIFICATION NUMBER
4	0004359769	OTHER	IN	AETNA

General Provider Information

NPI Number	:	1174526917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EDWARD MCCALLISTER MD

Provider Business Mailing Address
First Line	:	6920 PARKDALE PL
Second Line	:	STE 210
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5611
Country	:	US
Telephone Number	:	317-299-3444
Fax Number	:	317-299-8709

Provider Business Practice Location Address
First Line	:	6920 PARKDALE PL
Second Line	:	STE 210
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5611
Country	:	US
Telephone Number	:	317-299-3444
Fax Number	:	317-299-8709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/23/2010

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Directions to “ DR. ROBERT EDWARD MCCALLISTER MD” Practice Location

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