Healthcare Provider Details

I. General information

NPI: 1861498214
Provider Name (Legal Business Name): CHARLES J LANZAROTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 W OKLAHOMA AVE STE 100
MILWAUKEE WI
53215-4455
US

IV. Provider business mailing address

2025 W OKLAHOMA AVE STE 100
MILWAUKEE WI
53215-4455
US

V. Phone/Fax

Practice location:
  • Phone: 414-389-2790
  • Fax: 414-389-2791
Mailing address:
  • Phone: 414-389-2790
  • Fax: 414-389-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number38658
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38658
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: