Provider Demographics
NPI:1750349270
Name:LANZOTTI, VICTOR J (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:LANZOTTI
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 1:747 N RUTLEDGE ST
Mailing Address - Street 2:2204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6700
Mailing Address - Country:US
Mailing Address - Phone:217-525-2500
Mailing Address - Fax:217-525-9374
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:2204
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-525-2500
Practice Address - Fax:217-525-9374
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043018207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8415062OtherBLUE CROSS BLUE SHIELD
IL0360430182Medicaid
IL178281OtherHEALTHLINK
IL900001176OtherRAILROAD MEDICARE
IL178281OtherHEALTHLINK
IL8415062OtherBLUE CROSS BLUE SHIELD