Provider Demographics
NPI:1255313219
Name:LAZAR, MARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-551-5100
Mailing Address - Fax:248-551-2304
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 232
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-5100
Practice Address - Fax:248-551-2304
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055272207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19381Medicare UPIN
OF38173Medicare ID - Type Unspecified