Provider Demographics
NPI:1366437576
Name:KALLINS, MARC STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:STEPHEN
Last Name:KALLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3201
Mailing Address - Country:US
Mailing Address - Phone:941-761-1998
Mailing Address - Fax:941-748-8484
Practice Address - Street 1:4110 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1719
Practice Address - Country:US
Practice Address - Phone:941-748-8383
Practice Address - Fax:941-748-8484
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME405672081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068398100Medicaid
FL41201ZMedicare ID - Type Unspecified
FL068398100Medicaid
41201VMedicare PIN