Provider Demographics
NPI:1518790336
Name:CONEY, LAZARICK RON'E JR
Entity type:Individual
Prefix:MR
First Name:LAZARICK
Middle Name:RON'E
Last Name:CONEY
Suffix:JR
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 1:5833 W IOWA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2553
Mailing Address - Country:US
Mailing Address - Phone:312-647-6723
Mailing Address - Fax:
Practice Address - Street 1:1813 N MILL ST STE F
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4872
Practice Address - Country:US
Practice Address - Phone:630-536-8073
Practice Address - Fax:630-352-6462
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program