Provider Demographics
NPI:1245594134
Name:INTERCELLULAR SCIENCES, LLC
Entity Type:Organization
Organization Name:INTERCELLULAR SCIENCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CALCATERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-498-9114
Mailing Address - Street 1:9500 BONITA BEACH RD. #310
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-498-9114
Mailing Address - Fax:239-498-6555
Practice Address - Street 1:9500 BONITA BEACH RD. #310
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-498-9114
Practice Address - Fax:239-498-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center