Individual
LISA J KINSEY CALLAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-5039
(616) 685-3093
Mailing address
245 STATE ST SE, STE 228, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301070858
MI
208M00000X
Hospitalist Physician
Primary
4301070858
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104109912
BCBS OF MICHIGAN
MI
01
—
38-2145264
IRS
—
05
—
4196570
—
MI
Enumeration date
08/24/2006
Last updated
04/27/2022
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