Healthcare Provider Details

I. General information

NPI: 1053411736
Provider Name (Legal Business Name): CORINA LAZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DIVERSION ST. STE. 10 A
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

20300 CIVIC CENTER DRIVE STE. 303
SOUTHFIELD MI
48076-4169
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-8190
  • Fax: 248-559-8776
Mailing address:
  • Phone: 248-559-8190
  • Fax: 248-559-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301068313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: