Provider Demographics
NPI:1043300650
Name:LANTZ, KAREN ELISABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELISABETH
Last Name:LANTZ
Suffix:
Gender:F
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 510708
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84151-0708
Mailing Address - Country:US
Mailing Address - Phone:801-587-6600
Mailing Address - Fax:
Practice Address - Street 1:1743 REDSTONE CENTER DR
Practice Address - Street 2:STE. 115
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7929
Practice Address - Country:US
Practice Address - Phone:435-658-9200
Practice Address - Fax:435-658-9210
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5317761-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H30294Medicare UPIN