Provider Demographics
NPI:1477548808
Name:CALLAHAN, ELIZABETH F (MD, LLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MD, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7978 COOPER CREEK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2141
Mailing Address - Country:US
Mailing Address - Phone:941-308-7546
Mailing Address - Fax:941-308-7550
Practice Address - Street 1:7978 COOPER CREEK BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2141
Practice Address - Country:US
Practice Address - Phone:941-308-7546
Practice Address - Fax:941-308-7550
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1376576454OtherGROUP NPI
FL48310OtherBC PROVIDER#
FL00A58OtherBCBS GROUP ID
FL145A6OtherJANELLE BC#
FLME89181OtherST LICENSE#
FL00A58OtherBC/BS GROUP PRACTICE PROVIDER NUMBER
FL10D1031789OtherCLIA
FLK6441Medicare PIN
FL48310ZMedicare PIN
FLH35265Medicare UPIN
FL1376576454OtherGROUP NPI
FLP00203105Medicare PIN