Healthcare Provider Details

I. General information

NPI: 1235288416
Provider Name (Legal Business Name): GIANLUCA LAZZARO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E BELLEVUE PL 19B
CHICAGO IL
60611-1157
US

IV. Provider business mailing address

100 E BELLEVUE PL 19B
CHICAGO IL
60611-1157
US

V. Phone/Fax

Practice location:
  • Phone: 312-480-1945
  • Fax:
Mailing address:
  • Phone: 312-480-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036-097662
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-097662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: