Provider Demographics
NPI:1902892151
Name:CALLAHAN, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 18TH ST S STE 410
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-3805
Mailing Address - Country:US
Mailing Address - Phone:205-325-8620
Mailing Address - Fax:
Practice Address - Street 1:700 18TH ST S STE 410
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3805
Practice Address - Country:US
Practice Address - Phone:205-325-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006083207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000011042OtherMEDICARE PTAN
AL528500580Medicaid
AL51011042OtherBCBS
C75132Medicare UPIN
E376Medicare PIN
AL000011042OtherMEDICARE PTAN
0766130001Medicare NSC