Organization
BRAIN FUNCTION CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD MICHAEL KALTER PH.D. (OWNER SOLE PRACTITIONER)
(239) 403-8883
Entity
Organization
Contact information
Practice address
27499 RIVERVIEW CENTER BLVD, BONITA SPRINGS, FL 34134-4313
(239) 403-8883
(239) 403-8881
Mailing address
27499 RIVERVIEW CENTER BLVD, BONITA SPRINGS, FL 34134-4313
(239) 403-8883
(239) 403-8881
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY5251
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59727
BLUE CROSS
FL
Enumeration date
11/10/2010
Last updated
11/10/2010
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