Healthcare Provider Details

I. General information

NPI: 1710034129
Provider Name (Legal Business Name): MIGUEL J LANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 ALCAZAR AVE
CORAL GABLES FL
33134-4301
US

IV. Provider business mailing address

365 ALCAZAR AVE
CORAL GABLES FL
33134-4301
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-0441
  • Fax:
Mailing address:
  • Phone: 305-445-0441
  • Fax: 305-445-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME067980
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME067980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: