Provider Demographics
NPI:1033315346
Name:MARK A LAZAR DPM PC
Entity Type:Organization
Organization Name:MARK A LAZAR DPM PC
Other - Org Name:GREENWOOD FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-881-0788
Mailing Address - Street 1:720 FRY RD
Mailing Address - Street 2:STE. A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-2410
Mailing Address - Country:US
Mailing Address - Phone:317-881-0788
Mailing Address - Fax:317-889-0775
Practice Address - Street 1:720 FRY RD
Practice Address - Street 2:STE. A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2410
Practice Address - Country:US
Practice Address - Phone:317-881-0788
Practice Address - Fax:317-889-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-23
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000591213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200185200AMedicaid
IN1002540001Medicare NSC
INT34705Medicare UPIN
IN200185200AMedicaid