Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 48877 | AZ |
NPI | 1851599724 |
---|---|
Provider Name | Kelly L. Kantartzis |
First Address | Belfast, ME 04915-4012 |
Second Address | Mesa, AZ 85215-1134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 12/08/2015 |