Provider Demographics
NPI:1972548857
Name:KANTROWITZ, LAWRENCE J (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:KANTROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 N HABANA AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7123
Mailing Address - Country:US
Mailing Address - Phone:813-876-4900
Mailing Address - Fax:813-876-4997
Practice Address - Street 1:4600 N HABANA AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7123
Practice Address - Country:US
Practice Address - Phone:813-876-4900
Practice Address - Fax:813-876-4997
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06741OtherBCBS
P00478881OtherRAILROAD MEDICARE
FL06741OtherBCBS
CTH95151Medicare UPIN
FLAG787ZMedicare PIN