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General NPI Number Information
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NPI Number | 1366437576
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Entity Type | Individual
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Provider Name | MARC STEPHEN KALLINS MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 4110 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-1719
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Country | US
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Telephone | 941-748-8383
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Fax | 941-748-8484
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Provider Business Mailing Address
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Address Line | 315 75TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-3201
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Country | US
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Telephone | 941-761-1998
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Fax | 941-748-8484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME40567
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME40567
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License Number State | FL
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