Provider Demographics
NPI:1215924964
Name:CALLAGHAN, AMY L (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:498 INVERNESS TRL
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5244
Mailing Address - Country:US
Mailing Address - Phone:605-540-0358
Mailing Address - Fax:
Practice Address - Street 1:624 JONES STREET
Practice Address - Street 2:SUITE 5400
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-5283
Practice Address - Country:US
Practice Address - Phone:515-279-2510
Practice Address - Fax:712-279-2519
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA3086207R00000X, 208M00000X
SD6033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAH05912Medicare UPIN