Doctor Name: | DR. KURT THOMAS CALLISON |
NPI Number: | 1689014128 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 418 S Hamilton St Suite 109 Painted Post, NY - 148709705 |
Business Phone Number: | 6079362089 |
Business Fax Number: | 6079368176 |
Mailing Address: | 571 Saint Josephs Blvd Fl 2, ELMIRA |
State: | NY |
Postal Code: | 149013230 |
Phone Number: | 6072712050 |
Fax Number: | |
NPI Enumeration Date: | 06/28/2013 |
NPI Last Update Date: | 06/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |