Provider Demographics
NPI:1568671964
Name:CALLAN, MICHAEL DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:CALLAN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1640 FORT STREET
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2070 BIDDLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4080
Practice Address - Country:US
Practice Address - Phone:734-225-9100
Practice Address - Fax:734-225-9176
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
MI5101016780207XP3100X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H28427OtherBLUE CROSS
MI1699102244OtherGROUP NPI HENRY FORD WYANDOTTE
MIMI5976011Medicare PIN