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NPI Code Detail

MEDICARE: DR. MARK TRAVIS CALLESEN M.D.

MEDICARE: DR. MARK TRAVIS CALLESEN M.D.
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
12084P0800XPsychiatry Physician23058AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457461956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK TRAVIS CALLESEN M.D.
Provider Business Mailing Address
First Line : 3101 N CENTRAL AVE STE 550
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2635
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-682-7455
Provider Business Practice Location Address
First Line : 610 E BASELINE RD STE 5
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-6536
Country : US
Telephone Number : 602-230-7373
Fax Number : 602-441-5836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 11/21/2025

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