Provider Demographics
NPI:1710034129
Name:LANZ, MIGUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:J
Last Name:LANZ
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 1:365 ALCAZAR AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4301
Mailing Address - Country:US
Mailing Address - Phone:305-445-0441
Mailing Address - Fax:305-445-0443
Practice Address - Street 1:365 ALCAZAR AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4301
Practice Address - Country:US
Practice Address - Phone:305-445-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME067980207KA0200X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252786300Medicaid
FL252786300Medicaid
FLE0162BMedicare PIN