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General NPI Number Information
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NPI Number | 1487803698
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Entity Type | Organization
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Legal Business Name | CALLENBERGER ORTHOPEDIC SPECIALISTS LLC
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 205 N BANANA RIVER DR SUITE 103
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-2596
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Country | US
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Telephone | 321-305-4931
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Fax | 321-305-4933
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Provider Business Mailing Address
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Address Line | 205 N BANANA RIVER DR SUITE 103
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-2596
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Country | US
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Telephone | 321-305-4931
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Fax | 321-305-4933
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK STEVEN CALLENBERGER
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Credential | D.O.
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Telephone | 321-305-4931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 8441
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License Number State | FL
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