Basic Information
| Provider Information | |||||||||
| NPI: | 1811925480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANTOR NEPHROLOGY CONSULTANTS, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1750 E DESERT INN RD | ||||||||
| Address2: | #200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891693202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | 7027375328 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 E DESERT INN RD | ||||||||
| Address2: | #200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891093202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | 7027375043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAKIEDDINE | ||||||||
| AuthorizedOfficialFirstName: | MARWAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 7027322438 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 5398 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.