Healthcare Provider Details

I. General information

NPI: 1275509432
Provider Name (Legal Business Name): BARNETT RONALD KANTZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR. SUITE #2
DUNDEE MI
48131
US

IV. Provider business mailing address

100 POWELL DR. SUITE #2
DUNDEE MI
48131
US

V. Phone/Fax

Practice location:
  • Phone: 734-529-5900
  • Fax: 734-529-5999
Mailing address:
  • Phone: 734-529-5900
  • Fax: 734-529-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101013189
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101013189
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: