Provider Demographics
NPI:1750340089
Name:CALLUM, MICHAEL G (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:CALLUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:400 HIGHLAND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7003
Mailing Address - Country:US
Mailing Address - Phone:978-741-4133
Mailing Address - Fax:978-741-7742
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7003
Practice Address - Country:US
Practice Address - Phone:978-741-4133
Practice Address - Fax:978-741-7742
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-06-18
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Provider Licenses
StateLicense IDTaxonomies
MA152913208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0126560Medicaid
MAA32453Medicare ID - Type Unspecified
MA0126560Medicaid