Healthcare Provider Details

I. General information

NPI: 1427426865
Provider Name (Legal Business Name): LAZARO TRANSITIONS MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 S MICHIGAN RD
EATON RAPIDS MI
48827-9206
US

IV. Provider business mailing address

2285 S MICHIGAN RD
EATON RAPIDS MI
48827-9206
US

V. Phone/Fax

Practice location:
  • Phone: 517-386-1367
  • Fax:
Mailing address:
  • Phone: 517-386-1367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY R LAZARO
Title or Position: OWNER
Credential: MD
Phone: 810-692-4030