Provider Demographics
NPI:1073709374
Name:GARRICK KANTZLER M D P A
Entity Type:Organization
Organization Name:GARRICK KANTZLER M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:KANTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-562-2330
Mailing Address - Street 1:805 37TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6564
Mailing Address - Country:US
Mailing Address - Phone:772-562-2330
Mailing Address - Fax:772-562-2592
Practice Address - Street 1:805 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6564
Practice Address - Country:US
Practice Address - Phone:772-562-2330
Practice Address - Fax:772-562-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG54209Medicare UPIN
FL31093Medicare PIN