Provider Demographics
NPI:1417105065
Name:HERTZIG, LINDSAY LANE (MD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:LANE
Last Name:HERTZIG
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 1:10701 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1244
Mailing Address - Country:US
Mailing Address - Phone:913-338-5585
Mailing Address - Fax:
Practice Address - Street 1:10701 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1244
Practice Address - Country:US
Practice Address - Phone:913-338-5585
Practice Address - Fax:913-338-3228
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51938208800000X
MO2013027010208800000X
KS04-36645208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
49587015OtherBCBS
MOJ71A00015Medicare PIN
MN340001066Medicare PIN
49587015OtherBCBS