Healthcare Provider Details

I. General information

NPI: 1053073379
Provider Name (Legal Business Name): BRIAN THOMAS KALSTO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 7TH ST
APOPKA FL
32703-5327
US

IV. Provider business mailing address

225 E 7TH ST
APOPKA FL
32703-5327
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 407-886-4282
Mailing address:
  • Phone: 407-905-8827
  • Fax: 407-886-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: