MEDICARE: MR. LAWRENCE H ZAGER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	021001094	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	433159	OTHER		UNITED CONCORDIA
2	80006190	OTHER		BCBS

General Provider Information

NPI Number	:	1245227867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE H ZAGER DDS

Provider Business Mailing Address
First Line	:	25 E WASHINGTON ST
Second Line	:	# 825
City	:	CHICAGO
State	:	IL
Zip	:	60602-1708
Country	:	US
Telephone Number	:	312-372-0411
Fax Number	:	312-372-0428

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST
Second Line	:	# 825
City	:	CHICAGO
State	:	IL
Zip	:	60602-1708
Country	:	US
Telephone Number	:	312-372-0411
Fax Number	:	312-372-0428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	06/03/2015

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