Healthcare Provider Details

I. General information

NPI: 1710907381
Provider Name (Legal Business Name): MARK A LAZAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 FRY RD STE. A
GREENWOOD IN
46142-2410
US

IV. Provider business mailing address

6415 GREYRIDGE BLVD
INDIANAPOLIS IN
46237-3145
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-0788
  • Fax: 317-889-0775
Mailing address:
  • Phone: 317-788-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0700059-1
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: