Healthcare Provider Details

I. General information

NPI: 1194532457
Provider Name (Legal Business Name): SOPHIA LAZZARONI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRANSAM PLAZA DR STE 100
OAKBROOK TERRACE IL
60181-4286
US

IV. Provider business mailing address

1 TRANSAM PLAZA DR STE 100
OAKBROOK TERRACE IL
60181-4286
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-7500
  • Fax:
Mailing address:
  • Phone: 630-627-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.010980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: