Provider Demographics
NPI:1821312299
Name:SULIMANOV, LAZAR B
Entity Type:Individual
Prefix:
First Name:LAZAR
Middle Name:B
Last Name:SULIMANOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 E BELL RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2243
Mailing Address - Country:US
Mailing Address - Phone:602-910-7545
Mailing Address - Fax:
Practice Address - Street 1:4015 E BELL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2243
Practice Address - Country:US
Practice Address - Phone:602-910-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies