Basic Information
| Provider Information | |||||||||
| NPI: | 1316909864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANTOR | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 S BRUCE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891691778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1581 MOUNT MARIAH DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891061506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028530090 | ||||||||
| FaxNumber: | 7028530096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 12391 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 300692 | 05 | AZ | MEDICAID | 1316909864 | 05 | NV | MEDICAID |