Provider Demographics
NPI:1639300486
Name:KANTER, PAUL M (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:KANTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-0828
Mailing Address - Country:US
Mailing Address - Phone:317-518-7642
Mailing Address - Fax:847-267-9447
Practice Address - Street 1:348 WOODROW AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-0828
Practice Address - Country:US
Practice Address - Phone:317-518-7642
Practice Address - Fax:847-267-9447
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000570A213E00000X
PASC002269L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1043Medicare PIN