Individual
MARK G KANITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
2537 MOMENTUM PL, CHICAGO, IL 60689-5325
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301052977
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930083516
RAILROAD MEDICARE
MI
Enumeration date
07/17/2006
Last updated
09/15/2011
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