MEDICARE: DR. DANIEL LAZAR DPM

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	213E00000X	Podiatrist	4856351260	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00067283	OTHER	MI	MEDICARE RAILROAD INSURAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538183868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL LAZAR DPM

Provider Business Mailing Address
First Line	:	5160 EAGLE LAKE DR
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-1721
Country	:	US
Telephone Number	:	248-967-3668
Fax Number	:	248-967-0630

Provider Business Practice Location Address
First Line	:	5160 EAGLE LAKE DR
Second Line	:
City	:	WATERFORD TOWNSHIP
State	:	MI
Zip	:	48329-1721
Country	:	US
Telephone Number	:	248-967-3668
Fax Number	:	248-967-0630

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/12/2023

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