Provider Demographics
NPI:1205965563
Name:KANTZ, DANIEL S (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:KANTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2021 MERCY WAY STE 102
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-1307
Practice Address - Country:US
Practice Address - Phone:812-218-4630
Practice Address - Fax:812-218-6431
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002542A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000486161OtherANTHEM- NORTON ICC
KY00533030OtherMEDICARE- NORTON ICC
KY64068968Medicaid
KYP00822031OtherRAILROAD MEDICARE- ICC
IN02002542AOtherSTATE LICENSE
INP00408270OtherRAILROAD MEDICARE
KY084514OtherSIHO- NORTON ICC
IN200396790Medicaid