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NPI Code Detail

MEDICARE: TIMOTHY G. O'CALLAGHAN, D.O. P.C.

MEDICARE: TIMOTHY G. O'CALLAGHAN, D.O. P.C.
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
1207Q00000XFamily Medicine Physician009392MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CD6343OTHERMIMEDICARE RR GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2080E31000OTHERMIBC GROUP

General Provider Information

NPI Number : 1710185954
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIMOTHY G. O'CALLAGHAN, D.O. P.C.
Provider Business Mailing Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number :
Provider Business Practice Location Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : DR. TIMOTHY GERARD O'CALLAGHAN
Credential : D.O.
Telephone Number : 231-845-7380
Provider Enumeration Date : 07/10/2007
Last Update Date : 03/07/2023

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