Provider Demographics
NPI:1710328224
Name:LANTZ, PAUL GREGORY (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GREGORY
Last Name:LANTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 S MARYLAND AVE # NC9015
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1426
Mailing Address - Country:US
Mailing Address - Phone:773-834-7711
Mailing Address - Fax:773-834-7205
Practice Address - Street 1:5758 S MARYLAND AVE # NC9015
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-834-7711
Practice Address - Fax:773-834-7205
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000878213ES0103X
IL016.005737213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty