Provider Demographics
NPI:1053608885
Name:CALLAHAN, TYLER J (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0485
Mailing Address - Country:US
Mailing Address - Phone:765-521-1516
Mailing Address - Fax:765-599-3131
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-599-3177
Practice Address - Fax:765-599-3176
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004098A207Q00000X
IL036137237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02004098AOtherINDIANA LICENSE
NC201601361OtherLICENSE
IN201068140Medicaid
NC201601361OtherLICENSE