Provider Demographics
NPI:1013235431
Name:LAZARO JAVIER MD PC
Entity Type:Organization
Organization Name:LAZARO JAVIER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:ESGUERRA
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-648-3444
Mailing Address - Street 1:255 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1236
Mailing Address - Country:US
Mailing Address - Phone:810-648-3444
Mailing Address - Fax:810-648-3102
Practice Address - Street 1:255 WORTH ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1236
Practice Address - Country:US
Practice Address - Phone:810-648-3444
Practice Address - Fax:810-648-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILJ048712261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1657969Medicaid
MI0761510OtherBLUE CROSS
MI1657969Medicaid
MI0761510OtherBLUE CROSS