Provider Demographics
NPI:1871665711
Name:CALLAHAN, WILLIAM A
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:CALLAHAN
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 1:6525 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-920-6778
Mailing Address - Fax:952-920-3863
Practice Address - Street 1:6525 DREW AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-920-6778
Practice Address - Fax:952-920-3863
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN232372084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101740OtherUCARE
MN57Q80CAOtherBCBS MN
MN101740OtherUCARE