Provider Demographics
NPI:1649523044
Name:CORE ENT. LLC
Entity type:Organization
Organization Name:CORE ENT. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:W
Authorized Official - Last Name:KANTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-543-2867
Mailing Address - Street 1:PO BOX 8365
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-8365
Mailing Address - Country:US
Mailing Address - Phone:256-543-2867
Mailing Address - Fax:256-459-4791
Practice Address - Street 1:215 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4217
Practice Address - Country:US
Practice Address - Phone:256-543-2867
Practice Address - Fax:256-459-4791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0637207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL123503Medicaid
AL051559161Medicare PIN
AL123503Medicaid