Healthcare Provider Details

I. General information

NPI: 1629037304
Provider Name (Legal Business Name): LANTZ MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 GEORGIA ST
MERRILLVILLE IN
46410-6224
US

IV. Provider business mailing address

PO BOX 2153 DEPT 8031
BIRMINGHAM AL
35287-8031
US

V. Phone/Fax

Practice location:
  • Phone: 317-536-4870
  • Fax: 317-536-4872
Mailing address:
  • Phone: 317-536-4870
  • Fax: 317-536-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ADDINGTON
Title or Position: COMPLIANCE
Credential:
Phone: 317-536-4870