Provider Demographics
NPI:1720061328
Name:LAZAR, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:LAZAR
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:G3230 BEECHER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3604
Practice Address - Country:US
Practice Address - Phone:810-342-5656
Practice Address - Fax:810-342-5600
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802525141OtherBLUE CROSS BLUE SHIELD
MIC39417OtherHEALTH NET FEDERAL SERVIC
MIC39417OtherHAP
MI4301057348OtherHEALTHPLUS
MI010B56026OtherBLUE CROSS BLUE SHIELD
MI010B56026OtherCOMMUNITY BLUE PPO
MI1528OtherMCARE
MI3140103OtherMCLAREN HEALTH PLAN
MI3140103Medicaid
MI6883683006OtherCIGNA
MI010B56026OtherBLUE CARE NETWORK
MI3047029Medicaid
MI010B56026OtherBLUE CHOICE
MI3140103OtherHEALTH ADVANTAGE
MI4294644OtherAETNA
MI010B56026OtherBLUE CHOICE
MI3047029Medicaid