Provider Demographics
NPI:1306077086
Name:D S LAZAR DPM PC
Entity type:Organization
Organization Name:D S LAZAR DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-967-3668
Mailing Address - Street 1:15300 W 9 MILE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2584
Mailing Address - Country:US
Mailing Address - Phone:248-967-3668
Mailing Address - Fax:248-967-0630
Practice Address - Street 1:15300 W 9 MILE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2584
Practice Address - Country:US
Practice Address - Phone:248-967-3668
Practice Address - Fax:248-967-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001114213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1502974Medicaid
MIP00067283OtherMEDICARE RAILROAD INSURANCE
MI1502974Medicaid
MI3664001Medicare PIN
T34327Medicare UPIN