Individual
DR. SCOTT JAMES KANTOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
425 PINE RIDGE BLVD STE 200, WAUSAU, WI 54401-4123
(715) 847-0075
Mailing address
425 PINE RIDGE BLVD STE 200, WAUSAU, WI 54401-4123
(715) 847-0075
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
61844
WI
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
54706
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32907900
—
WI
Enumeration date
04/10/2008
Last updated
04/03/2025
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