Healthcare Provider Details

I. General information

NPI: 1093283780
Provider Name (Legal Business Name): RUDY LAZARO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD
HOFFMAN ESTATES IL
60169-1019
US

IV. Provider business mailing address

750 ALHAMBRA LN
HOFFMAN ESTATES IL
60169-1910
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-2000
  • Fax:
Mailing address:
  • Phone: 224-622-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.378020
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.018799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: