Healthcare Provider Details

I. General information

NPI: 1144885500
Provider Name (Legal Business Name): BRET MICHAEL KALINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4269 PEARL RD
CLEVELAND OH
44109-4234
US

IV. Provider business mailing address

4269 PEARL RD
CLEVELAND OH
44109-4234
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-4131
  • Fax:
Mailing address:
  • Phone: 216-431-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2002427
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.1901694-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: