MEDICARE: DR. ROBERT JOHN KANTOR 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	A82915	CA

General Provider Information

NPI Number	:	1770522401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOHN KANTOR M.D.

Provider Business Mailing Address
First Line	:	1620 44TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-5002
Country	:	US
Telephone Number	:	162-436-2626
Fax Number	:	616-243-6969

Provider Business Practice Location Address
First Line	:	1620 44TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-5002
Country	:	US
Telephone Number	:	162-436-2626
Fax Number	:	616-243-6969

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	10/15/2018

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