MEDICARE: DR. MARIO A LANZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3753	AK
2	207Q00000X	Family Medicine Physician	04-43901	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790756856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO A LANZA MD

Provider Business Mailing Address
First Line	:	720 MEDICAL CENTER DR
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-8778
Country	:	US
Telephone Number	:	316-283-6103
Fax Number	:	316-283-1333

Provider Business Practice Location Address
First Line	:	720 MEDICAL CENTER DR
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-8778
Country	:	US
Telephone Number	:	316-283-6103
Fax Number	:	907-258-1257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	11/12/2020

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Directions to “ DR. MARIO A LANZA MD” Practice Location

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