Healthcare Provider Details

I. General information

NPI: 1316963077
Provider Name (Legal Business Name): PINNACLE MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 75TH ST W
BRADENTON FL
34209-3201
US

IV. Provider business mailing address

315 75TH ST W
BRADENTON FL
34209-3201
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-1998
  • Fax: 941-761-0395
Mailing address:
  • Phone: 941-761-1998
  • Fax: 941-761-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6258
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME34789
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME13523
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME44610
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME11749
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME64188
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME68033
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME74784
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME40567
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME72170
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18064
License Number StateFL

VIII. Authorized Official

Name: DR. MARC STEPHEN KALLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 941-750-0602