MEDICARE: DR. JEFFREY P. CALLEN 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
1	207N00000X	Dermatology Physician	18911	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1508872821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY P. CALLEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 950132
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0132
Country	:	US
Telephone Number	:	888-980-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 SPRINGHURST BLVD
Second Line	:	SUITE 200
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6100
Country	:	US
Telephone Number	:	502-583-1749
Fax Number	:	502-329-8184

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/17/2018

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Directions to “ DR. JEFFREY P. CALLEN M.D.” Practice Location

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