Individual
JACOB TYLER MCCALLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8430 MARKET ST APT 118, MIDDLETON, WI 53562-4782
(612) 328-1583
Mailing address
8430 MARKET ST APT 118, MIDDLETON, WI 53562-4782
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
5101024188
MI
2085R0202X
Diagnostic Radiology Physician
Primary
81114
WI
Other
Enumeration date
06/28/2018
Last updated
07/23/2024
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