Provider Demographics
NPI:1053533851
Name:KANZE, DAVID M (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KANZE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 E LANCASTER AVE STE 201B
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2146
Mailing Address - Country:US
Mailing Address - Phone:267-437-3299
Mailing Address - Fax:158-481-6002
Practice Address - Street 1:300 E LANCASTER AVE STE 201B
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2146
Practice Address - Country:US
Practice Address - Phone:267-437-3299
Practice Address - Fax:158-481-6002
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60448689204D00000X, 207Q00000X
CO47690204D00000X, 207Q00000X
PAOS018844207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053533851Medicaid