Healthcare Provider Details

I. General information

NPI: 1689693582
Provider Name (Legal Business Name): MICHAEL EDWIN LAZARUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #365,530,420,120
LOS ANGELES CA
90095
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 200
LOS ANGELES CA
90045-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9643
  • Fax:
Mailing address:
  • Phone: 310-267-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA76992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: