1427049295 NPI number — MR. GEORGE PATRICK CANTINI PA

Table of content: MR. GEORGE PATRICK CANTINI PA (NPI 1427049295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427049295 NPI number — MR. GEORGE PATRICK CANTINI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTINI
Provider First Name:
GEORGE
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427049295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SPRING RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-472-8800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 W THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-865-5501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2149 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3981220 . This is a "EVERCARE GROUP #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 462341 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 453051001 . This is a "GROUP HEALTH GRP #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860373636 . This is a "HUMANA GROUP #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AW1436 . This is a "HEALTHNET GRP #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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