Provider Demographics
NPI:1164418851
Name:ANDREW PAUL LAZAR MDSL
Entity Type:Organization
Organization Name:ANDREW PAUL LAZAR MDSL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-433-1501
Mailing Address - Street 1:767 PARK AVE W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2400
Mailing Address - Country:US
Mailing Address - Phone:847-433-1501
Mailing Address - Fax:847-433-7913
Practice Address - Street 1:767 PARK AVE W
Practice Address - Street 2:SUITE 130
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2400
Practice Address - Country:US
Practice Address - Phone:847-433-1501
Practice Address - Fax:847-433-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
209996Medicare ID - Type Unspecified
K10683Medicare ID - Type Unspecified
D16429Medicare UPIN