Provider Demographics
NPI:1689646234
Name:KANTIS, GEORGE A (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:KANTIS
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:PO BOX 73627
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3627
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4100
Practice Address - Country:US
Practice Address - Phone:281-444-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042512207R00000X, 208M00000X
TXM8751207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196290401Medicaid
CT001425124Medicaid
CTP00272897OtherRAILROAD MEDICARE
TXP00653272OtherMEDICARE RR
CTP00272897OtherRAILROAD MEDICARE
CT001425124Medicaid
I23306Medicare UPIN