Provider Demographics
NPI:1427049295
Name:CANTINI, GEORGE PATRICK (PA)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:PATRICK
Last Name:CANTINI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SPRING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1804
Mailing Address - Country:US
Mailing Address - Phone:630-472-8800
Mailing Address - Fax:
Practice Address - Street 1:5555 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4622
Practice Address - Country:US
Practice Address - Phone:602-865-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2149207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GROUP #
AZ462341Medicaid
AZ453051001OtherGROUP HEALTH GRP #
AZ860373636OtherHUMANA GROUP #
AZAW1436OtherHEALTHNET GRP #
AZ453051001OtherGROUP HEALTH GRP #
AZ462341Medicaid
AZ3981220OtherEVERCARE GROUP #