Healthcare Provider Details

I. General information

NPI: 1124239207
Provider Name (Legal Business Name): NINA LAZOVIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 LAGORCE DR 6131 LA GORCE DRIVE
MIAMI BEACH FL
33140-2118
US

IV. Provider business mailing address

6131 LAGORCE DR 6131 LA GORCE DRIVE
MIAMI BEACH FL
33140-2118
US

V. Phone/Fax

Practice location:
  • Phone: 305-772-7697
  • Fax:
Mailing address:
  • Phone: 305-772-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME98974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: