Provider Demographics
NPI:1063949030
Name:MCCALLUM, JARED DAVID (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:DAVID
Last Name:MCCALLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:CANADA
Mailing Address - Zip Code:N9J3L6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:62-1262 DON MILLS RD
Practice Address - Street 2:
Practice Address - City:NORTH YORK
Practice Address - State:ONTARIO
Practice Address - Zip Code:M3B 2W7
Practice Address - Country:CA
Practice Address - Phone:416-335-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2023-06-29
Deactivation Date:2017-12-28
Deactivation Code:
Reactivation Date:2018-10-09
Provider Licenses
StateLicense IDTaxonomies
MST-45822081P2900X
MI4351027117208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine