Individual
CHARLES X MCCALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 355-3688
(812) 355-3656
Mailing address
9000 NEWANNA LN, NASHVILLE, IN 47448-8021
(812) 988-4318
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028978A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110341
ANTHEM
IN
Enumeration date
10/06/2006
Last updated
05/08/2019
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