MEDICARE: DR. BARNETT RONALD KANTZ D.O.

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	207P00000X	Emergency Medicine Physician	5101013189	MI
2	207R00000X	Internal Medicine Physician	5101013189	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0155810495	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1275509432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARNETT RONALD KANTZ D.O.

Provider Business Mailing Address
First Line	:	100 POWELL DR.
Second Line	:	SUITE #2
City	:	DUNDEE
State	:	MI
Zip	:	48131
Country	:	US
Telephone Number	:	734-529-5900
Fax Number	:	734-529-5999

Provider Business Practice Location Address
First Line	:	100 POWELL DR.
Second Line	:	SUITE #2
City	:	DUNDEE
State	:	MI
Zip	:	48131
Country	:	US
Telephone Number	:	734-529-5900
Fax Number	:	734-529-5999

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	11/03/2023

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