Provider Demographics
NPI:1124055538
Name:LANTZ, MELISSA M (DO)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:LANTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:LANTZ-EINREINHOFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1100
Mailing Address - Fax:952-942-3361
Practice Address - Street 1:33 PROVINCE LINE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7543
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:952-942-3361
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB068030002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001664364Medicaid
PA2967462OtherMEDICAL ASSISTANCE NY
PA047209OtherHIGHMARK BS
PA16643640009OtherMEDICAL ASSISTANCE PA
PA001664364Medicaid
PA16643640009OtherMEDICAL ASSISTANCE PA