Healthcare Provider Details

I. General information

NPI: 1043300650
Provider Name (Legal Business Name): KAREN ELISABETH LANTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 REDSTONE CENTER DR STE. 115
PARK CITY UT
84098-7929
US

IV. Provider business mailing address

PO BOX 510708
SALT LAKE CITY UT
84151-0708
US

V. Phone/Fax

Practice location:
  • Phone: 435-658-9200
  • Fax: 435-658-9210
Mailing address:
  • Phone: 801-587-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5317761-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: