1124055538 NPI number — DR. MELISSA M LANTZ DO

Table of content: DR. MELISSA M LANTZ DO (NPI 1124055538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124055538 NPI number — DR. MELISSA M LANTZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANTZ
Provider First Name:
MELISSA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANTZ-EINREINHOFER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124055538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11995 SINGLETREE LN
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-595-1100
Provider Business Mailing Address Fax Number:
952-942-3361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 PROVINCE LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-7543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-595-1100
Provider Business Practice Location Address Fax Number:
952-942-3361
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  25MB06803000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001664364 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2967462 . This is a "MEDICAL ASSISTANCE NY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 047209 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 16643640009 . This is a "MEDICAL ASSISTANCE PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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