Provider Demographics
NPI:1093895039
Name:JAVIER, LAZARO ESGUERRA (MD PC)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:ESGUERRA
Last Name:JAVIER
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1236
Mailing Address - Country:US
Mailing Address - Phone:810-648-3444
Mailing Address - Fax:810-648-3102
Practice Address - Street 1:394 LORAINE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1074
Practice Address - Country:US
Practice Address - Phone:810-648-3444
Practice Address - Fax:810-648-3102
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1657969-10Medicaid
MI0761510Medicare ID - Type Unspecified
MI1657969-10Medicaid