Provider Demographics
NPI:1508117219
Name:FRANK D LAZZERINI MD LLC
Entity Type:Organization
Organization Name:FRANK D LAZZERINI MD LLC
Other - Org Name:PREMIERE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAZZERINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-603-3893
Mailing Address - Street 1:7452 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9393
Mailing Address - Country:US
Mailing Address - Phone:330-830-6211
Mailing Address - Fax:330-830-6212
Practice Address - Street 1:7452 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9393
Practice Address - Country:US
Practice Address - Phone:330-830-6211
Practice Address - Fax:330-830-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35092741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2983393Medicaid
OH2983393Medicaid