Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | ME40567 | FL |
N | 2081P2900X | Pain Medicine | ME40567 | FL |
NPI | 1366437576 |
---|---|
Provider Name | Marc Stephen Kallins |
First Address | Bradenton, FL 34209-3201 |
Second Address | Bradenton, FL 34205-1719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068398100 | (05) | FL |