Healthcare Provider Details

I. General information

NPI: 1770118481
Provider Name (Legal Business Name): LAZCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W SOUTH BOULDER RD STE 102
LAFAYETTE CO
80026-8952
US

IV. Provider business mailing address

2538 OWL CREEK DR
FORT COLLINS CO
80528-3141
US

V. Phone/Fax

Practice location:
  • Phone: 602-625-3036
  • Fax:
Mailing address:
  • Phone: 602-625-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHEEN SHEIKH
Title or Position: PHYSICIAN
Credential: MD
Phone: 602-625-3036