Provider Demographics
NPI:1396964417
Name:CALLAHAN PODIATRY INC
Entity type:Organization
Organization Name:CALLAHAN PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-320-9954
Mailing Address - Street 1:2290 LAKEVIEW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-4201
Mailing Address - Country:US
Mailing Address - Phone:937-320-9954
Mailing Address - Fax:
Practice Address - Street 1:2290 LAKEVIEW DR
Practice Address - Street 2:SUITE B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4201
Practice Address - Country:US
Practice Address - Phone:937-320-9954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002571C213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA0851742Medicare ID - Type Unspecified
OHT89997Medicare UPIN