MEDICARE: DR. MATTHEW DENNIS LAZZARA M.D.

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	207W00000X	Ophthalmology Physician		IL

General Provider Information

NPI Number	:	1720264724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DENNIS LAZZARA M.D.

Provider Business Mailing Address
First Line	:	2252 N CLEVELAND AVE
Second Line	:	APT 3F
City	:	CHICAGO
State	:	IL
Zip	:	60614-3766
Country	:	US
Telephone Number	:	202-498-5921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2252 N CLEVELAND AVE
Second Line	:	APT 3F
City	:	CHICAGO
State	:	IL
Zip	:	60614-3766
Country	:	US
Telephone Number	:	202-498-5921
Fax Number	:

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

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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