Individual
DR. MICHAEL T. CALLAGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S 11TH AVE, SUITE 101, POCATELLO, ID 83201-4835
(208) 239-1750
(208) 239-1771
Mailing address
PO BOX 4908, POCATELLO, ID 83205-4908
(208) 236-1600
(208) 236-6695
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
M-7264
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805081800
—
ID
01
—
J4779
BLUE CROSS OF IDAHO
ID
Enumeration date
07/05/2006
Last updated
02/17/2010
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