Healthcare Provider Details

I. General information

NPI: 1043272271
Provider Name (Legal Business Name): VINCI DIAGNOSTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE
MUNSTER IN
46321-4037
US

IV. Provider business mailing address

PO BOX 957
SCHERERVILLE IN
46375-0957
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-2085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMENICO LAZZARO
Title or Position: PRESIDENT
Credential: MD
Phone: 219-934-2085