Healthcare Provider Details

I. General information

NPI: 1265450944
Provider Name (Legal Business Name): ROBERT KANTERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3417
US

IV. Provider business mailing address

55 W PORT PLZ SUITE 300
SAINT LOUIS MO
63146-3109
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6100
  • Fax: 314-878-5437
Mailing address:
  • Phone: 314-471-8323
  • Fax: 770-237-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number107792
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number107792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: