Provider Demographics
NPI:1902195746
Name:LAZARUS, MARK AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:AARON
Last Name:LAZARUS
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 1:1441 W FLOURNOY ST
Mailing Address - Street 2:2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3210
Mailing Address - Country:US
Mailing Address - Phone:847-830-3636
Mailing Address - Fax:
Practice Address - Street 1:435 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4307
Practice Address - Country:US
Practice Address - Phone:619-691-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine