Provider Demographics
NPI:1568582807
Name:CALLISTER, TODD RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RICHARD
Last Name:CALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTH MADISON ST
Mailing Address - Street 2:PO BOX 351
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963
Mailing Address - Country:US
Mailing Address - Phone:920-324-6235
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH MADISON ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963
Practice Address - Country:US
Practice Address - Phone:920-324-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43091-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry