Provider Demographics
NPI:1225684202
Name:LAZURKA, NICHOLAS TRIPP ((PA-C))
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:TRIPP
Last Name:LAZURKA
Suffix:
Gender:M
Credentials:(PA-C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 SCHUST RD APT 206
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8102
Mailing Address - Country:US
Mailing Address - Phone:810-304-7879
Mailing Address - Fax:
Practice Address - Street 1:3085 HALLMARK CT STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6803
Practice Address - Country:US
Practice Address - Phone:989-996-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI56010095332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry