Individual provider · Type 1 NPI

Craig Stephen Kantack, PA-C

Medical Physician Assistant · Idaho Falls, ID

NPI number 1699052357 Active

Practice location

740 S Woodruff Ave
Idaho Falls, ID 83401-5285

Call (208) 542-9111 Map

Mailing address

944 W 97th S
Idaho Falls, ID 83402-5842

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA-984 (ID)

Medical Physician Assistant: Definition to come...

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About NPI 1699052357

Craig Stephen Kantack, PA-C's National Provider Identifier is 1699052357, issued on Nov 9, 2011. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Idaho Falls, ID. The record was last updated on Apr 12, 2023.