Provider Demographics
NPI:1275509432
Name:KANTZ, BARNETT RONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:BARNETT
Middle Name:RONALD
Last Name:KANTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POWELL DR.
Mailing Address - Street 2:SUITE #2
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131
Mailing Address - Country:US
Mailing Address - Phone:734-529-5900
Mailing Address - Fax:734-529-5999
Practice Address - Street 1:100 POWELL DR.
Practice Address - Street 2:SUITE #2
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131
Practice Address - Country:US
Practice Address - Phone:734-529-5900
Practice Address - Fax:734-529-5999
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013189207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0155810495OtherBCBS
MI202102022OtherTIN
MIG96932Medicare UPIN
MI0P25710Medicare ID - Type Unspecified