Provider Demographics
NPI:1598035016
Name:LARA, VIOLETA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIOLETA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIOLETA
Other - Middle Name:
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:540 LAKE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1938
Mailing Address - Country:US
Mailing Address - Phone:386-864-1466
Mailing Address - Fax:
Practice Address - Street 1:540 LAKE AVE APT 5
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1938
Practice Address - Country:US
Practice Address - Phone:386-864-1466
Practice Address - Fax:906-228-7192
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039412207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology