Healthcare Provider Details

I. General information

NPI: 1396192720
Provider Name (Legal Business Name): GREGORY GEORGE LAZARZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

IV. Provider business mailing address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

V. Phone/Fax

Practice location:
  • Phone: 216-861-6200
  • Fax:
Mailing address:
  • Phone: 216-861-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.028008
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: