MEDICARE: TOP BRAINS CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0301X	Brain Injury Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1063254258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOP BRAINS CENTERS LLC

Provider Business Mailing Address
First Line	:	12381 S CLEVELAND AVE STE 402
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:	561-541-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12381 S CLEVELAND AVE STE 402
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:	561-541-1000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANZHELA MORMITKO
Credential	:
Telephone Number	:	561-541-1000

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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