Provider Demographics
NPI:1255580593
Name:CALLAHAN, DANIEL CHOYCE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHOYCE
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-0445
Mailing Address - Country:US
Mailing Address - Phone:800-514-4390
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:2204 N SECTION ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882
Practice Address - Country:US
Practice Address - Phone:812-268-2556
Practice Address - Fax:812-268-2652
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1474962084P2900X
MI43010997222084P2900X
IN01080614A2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300017765Medicaid