Healthcare Provider Details

I. General information

NPI: 1306793609
Provider Name (Legal Business Name): THOMAS JOHN KANTARAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 E STILL CIR
MESA AZ
85206-3618
US

IV. Provider business mailing address

4510 E BANNER GATEWAY DR APT 3120
MESA AZ
85206-4760
US

V. Phone/Fax

Practice location:
  • Phone: 480-248-8107
  • Fax:
Mailing address:
  • Phone: 330-814-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: