Provider Demographics
NPI:1275791089
Name:EDWARD LAZZARIN, MD, PA
Entity Type:Organization
Organization Name:EDWARD LAZZARIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-5989
Mailing Address - Street 1:6085 BIRD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5254
Mailing Address - Country:US
Mailing Address - Phone:305-663-5989
Mailing Address - Fax:305-663-5989
Practice Address - Street 1:6085 BIRD RD STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5254
Practice Address - Country:US
Practice Address - Phone:305-663-5989
Practice Address - Fax:305-663-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
FLME36257261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96214Medicare PIN
FLD27962Medicare UPIN