Provider Demographics
NPI:1669041679
Name:MCCALLEY, ZACHARY
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MCCALLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 RICHFIELD PKWY APT 132
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-7518
Mailing Address - Country:US
Mailing Address - Phone:952-999-2080
Mailing Address - Fax:
Practice Address - Street 1:4444 W 76TH ST STE 400&600
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5173
Practice Address - Country:US
Practice Address - Phone:612-746-7347
Practice Address - Fax:612-746-7348
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant