Most Relevant Information
Provider Data
| NPI Number: | 1003239500 |
| Provider Name: | GINA MARIE O'CALLAGHAN PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 2108 |
Most Important Dates
| Enumeration Date: | 02/04/2014 |
| Last Updated: | 09/28/2020 |
Provider Practice Location
3000 OLD CENTRE RD
PORTAGE
MI
490244883
Practice Location Phone/Fax
| Phone: | 2693217546 |
| Fax: | 2693211705 |
Provider Mailing Location
2180 HENRY TECKLENBURG DR
CHARLESTON
SC
294145798
Provider Mailing Phone/Fax
| Phone: | 8435568886 |
| Fax: |