Healthcare Provider Details

I. General information

NPI: 1134386857
Provider Name (Legal Business Name): BARNETT R. KANTZ, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR SUITE 2
DUNDEE MI
48131-8644
US

IV. Provider business mailing address

100 POWELL DR SUITE 2
DUNDEE MI
48131-8644
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 TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101013189
License Number StateMI

VIII. Authorized Official

Name: DR. BARNETT RONALD KANTZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 734-529-5900