Provider Demographics
NPI:1689642282
Name:MCCALLUM, GREGORY G (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:MCCALLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1100 EAST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283
Mailing Address - Country:US
Mailing Address - Phone:507-637-2985
Mailing Address - Fax:507-637-6678
Practice Address - Street 1:1100 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283
Practice Address - Country:US
Practice Address - Phone:507-637-2985
Practice Address - Fax:507-637-6678
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN950365000Medicaid