Individual
DR. MARK C KLISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4100 W KENNEDY BLVD, SUITE 327, TAMPA, FL 33609-2288
(813) 288-8060
(813) 288-8068
Mailing address
4100 W KENNEDY BLVD, SUITE 327, TAMPA, FL 33609-2288
(813) 288-8060
(813) 288-8068
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY3077
FL
103TC0700X
Clinical Psychologist
Primary
PY3077
FL
Other
Enumeration date
05/12/2006
Last updated
02/19/2008
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