Provider Demographics
NPI:1821814757
Name:LAZO MEDICAL LLC
Entity type:Organization
Organization Name:LAZO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-235-1864
Mailing Address - Street 1:1229 GILMORE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-2307
Mailing Address - Country:US
Mailing Address - Phone:502-235-1864
Mailing Address - Fax:
Practice Address - Street 1:1229 GILMORE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2307
Practice Address - Country:US
Practice Address - Phone:502-235-1864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty