Provider Demographics
NPI:1720060825
Name:MCCALLA, RYAN J (DPM PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:MCCALLA
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1406
Mailing Address - Country:US
Mailing Address - Phone:785-354-7608
Mailing Address - Fax:785-354-4202
Practice Address - Street 1:2010 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1406
Practice Address - Country:US
Practice Address - Phone:785-354-7608
Practice Address - Fax:785-354-4202
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114153OtherBLUE CROSS BLUE SHIELD IND. NUMBER
KS12-00300OtherSTATE LICENSE
KS12-00300OtherSTATE LICENSE
KSU65935Medicare UPIN
KS480025760Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
KS114153OtherBLUE CROSS BLUE SHIELD IND. NUMBER