Provider Demographics
NPI:1124446166
Name:LAZORITZ, JOHN P (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:LAZORITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5353
Mailing Address - Country:US
Mailing Address - Phone:586-977-6497
Mailing Address - Fax:
Practice Address - Street 1:3500 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5353
Practice Address - Country:US
Practice Address - Phone:586-977-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE365213E00000X
MI5901400531213ES0103X
IA086664213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist