Provider Demographics
NPI:1285657411
Name:CALLAN, JOHN MICHAEL (C O)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:CALLAN
Suffix:
Gender:M
Credentials:C O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1358
Mailing Address - Country:US
Mailing Address - Phone:719-799-6529
Mailing Address - Fax:719-799-6530
Practice Address - Street 1:1729 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7503
Practice Address - Country:US
Practice Address - Phone:719-799-6529
Practice Address - Fax:719-799-6530
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07329800222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5491920001OtherMEDICARE SUPPLIER
CO77100069Medicaid
CO1346428992OtherTRICARE
TX5491920001Medicare ID - Type UnspecifiedPALMETTO GBA-H
TX17417Medicaid
TX1752937079OtherTEXAS REHABILITATION
TX531934OtherBLUE CROSS BLUE SHIELD