Provider Demographics
NPI:1992076079
Name:LANTZ, STEPHEN MORRELL (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MORRELL
Last Name:LANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11717 N OGDEN POINT RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-8724
Mailing Address - Country:US
Mailing Address - Phone:574-389-1231
Mailing Address - Fax:574-389-1232
Practice Address - Street 1:22818 OLD US 20
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9150
Practice Address - Country:US
Practice Address - Phone:574-389-1231
Practice Address - Fax:574-389-1232
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01021528A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine