Provider Demographics
NPI:1770522401
Name:KANTOR, ROBERT JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:KANTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1620 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5002
Mailing Address - Country:US
Mailing Address - Phone:162-436-2626
Mailing Address - Fax:616-243-6969
Practice Address - Street 1:1620 44TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5002
Practice Address - Country:US
Practice Address - Phone:162-436-2626
Practice Address - Fax:616-243-6969
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA829152083P0500X
MI43010661772083P0500X
OH35-0777392083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG94937Medicare UPIN