Provider Demographics
NPI:1235288416
Name:LAZZARO, GIANLUCA (MD)
Entity Type:Individual
Prefix:DR
First Name:GIANLUCA
Middle Name:
Last Name:LAZZARO
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 1:100 E BELLEVUE PL
Mailing Address - Street 2:19B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1157
Mailing Address - Country:US
Mailing Address - Phone:312-480-1945
Mailing Address - Fax:
Practice Address - Street 1:100 E BELLEVUE PL
Practice Address - Street 2:19B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1157
Practice Address - Country:US
Practice Address - Phone:312-480-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0976622086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615715OtherBLUE CROSS BLUE SHIELD