MEDICARE: GARRICK B KANTZLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	000122-0000169	FL

General Provider Information

NPI Number	:	1720197080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRICK B KANTZLER M.D.

Provider Business Mailing Address
First Line	:	805 37TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6564
Country	:	US
Telephone Number	:	772-562-2330
Fax Number	:	772-562-2592

Provider Business Practice Location Address
First Line	:	805 37TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6564
Country	:	US
Telephone Number	:	772-562-2330
Fax Number	:	772-562-2592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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