Provider Demographics
NPI:1053304758
Name:MCCALLUM, LEE WILKES (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:WILKES
Last Name:MCCALLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-0881
Mailing Address - Fax:901-516-0528
Practice Address - Street 1:1385 W BRIERBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2208
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-752-2385
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4057032OtherAETNA
TN2623978OtherCIGNA
TN140818OtherUNITED HEALTHCARE
TN140818OtherUNITED HEALTHCARE
TN103I088493Medicare PIN