Healthcare Provider Details

I. General information

NPI: 1346430998
Provider Name (Legal Business Name): CATHY JANE LAZARUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 LEONARD WOOD S APT 205
HIGHLAND PARK IL
60035-5934
US

IV. Provider business mailing address

3333 GREEN BAY RD
NORTH CHICAGO IL
60064-3037
US

V. Phone/Fax

Practice location:
  • Phone: 847-681-0549
  • Fax:
Mailing address:
  • Phone: 847-578-3295
  • Fax: 847-578-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10611R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: