Provider Demographics
NPI:1033433347
Name:KANTHAK, ROBERT (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:KANTHAK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 HOLDERMAN PL
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-1514
Mailing Address - Country:US
Mailing Address - Phone:937-687-6139
Mailing Address - Fax:
Practice Address - Street 1:442 HOLDERMAN PL
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-1514
Practice Address - Country:US
Practice Address - Phone:937-687-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 132015 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse