Provider Demographics
NPI:1710978689
Name:LAZZARA, R SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:SCOTT
Last Name:LAZZARA
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 1:2866 SANDHURST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4553
Mailing Address - Country:US
Mailing Address - Phone:586-292-6003
Mailing Address - Fax:
Practice Address - Street 1:2866 SANDHURST
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4553
Practice Address - Country:US
Practice Address - Phone:586-292-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104354070Medicaid
MI110F324370OtherBCBSM
MI3463285Medicaid
MI104354070Medicaid
MI3463285Medicaid
G57907Medicare UPIN