Provider Demographics
NPI:1083603500
Name:LAZARCZYK, DARIUSZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIUSZ
Middle Name:A
Last Name:LAZARCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 W MAPLE RD
Mailing Address - Street 2:#200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5435
Mailing Address - Country:US
Mailing Address - Phone:248-273-9930
Mailing Address - Fax:248-273-9931
Practice Address - Street 1:264 W MAPLE RD
Practice Address - Street 2:#200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5435
Practice Address - Country:US
Practice Address - Phone:248-273-9930
Practice Address - Fax:248-273-9931
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI063367207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4163102Medicaid
MIOM10030007Medicare ID - Type Unspecified
MI4163102Medicaid