MEDICARE: WALTER S KANTOR DPM INC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	E3318	CA

General Provider Information

NPI Number	:	1912377680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER S KANTOR DPM INC

Provider Business Mailing Address
First Line	:	23412 MOULTON PKWY
Second Line	:	SUITE 100
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1732
Country	:	US
Telephone Number	:	949-300-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	23412 MOULTON PKWY
Second Line	:	SUITE 100
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1732
Country	:	US
Telephone Number	:	949-300-0615
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. WALTER STANLEY KANTOR
Credential	:	DPM
Telephone Number	:	949-300-0615

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/06/2015

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