MEDICARE: SAMUEL ADAM KANTOR M.D.

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	207RN0300X	Nephrology Physician	12391	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316909864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL ADAM KANTOR M.D.

Provider Business Mailing Address
First Line	:	2545 S BRUCE ST STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-1778
Country	:	US
Telephone Number	:	702-732-2438
Fax Number	:	702-737-5043

Provider Business Practice Location Address
First Line	:	1581 MOUNT MARIAH DR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-1506
Country	:	US
Telephone Number	:	702-851-7766
Fax Number	:	702-851-7760

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	05/10/2024

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