Healthcare Provider Details

I. General information

NPI: 1275791089
Provider Name (Legal Business Name): EDWARD LAZZARIN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 BIRD RD STE 101
MIAMI FL
33155-5254
US

IV. Provider business mailing address

6085 BIRD RD STE 101
MIAMI FL
33155-5254
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-5989
  • Fax: 305-663-5989
Mailing address:
  • Phone: 305-663-5989
  • Fax: 305-663-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME36257
License Number StateFL

VIII. Authorized Official

Name: EDWARD LAZZARIN
Title or Position: DIRECTOR
Credential: MD
Phone: 305-663-5989