Provider Demographics
NPI:1538330980
Name:MCALLISTER, SHANE CAMERON (MD PHD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:CAMERON
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2512 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1404
Mailing Address - Country:US
Mailing Address - Phone:612-365-6777
Mailing Address - Fax:612-365-8001
Practice Address - Street 1:2512 SOUTH 7TH STREET
Practice Address - Street 2:PEDIATRIC SPECIALTY CARE - 7TH STREET
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1404
Practice Address - Country:US
Practice Address - Phone:612-365-6777
Practice Address - Fax:612-624-1446
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55953208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics