Healthcare Provider Details

I. General information

NPI: 1124393228
Provider Name (Legal Business Name): LARA SPERANZA LAZARRE RIES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA S LAZARRE M.D.

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S BUSINESS PARK DR STE A6
OOSTBURG WI
53070-1586
US

IV. Provider business mailing address

220 S BUSINESS PARK DR STE A6
OOSTBURG WI
53070-1586
US

V. Phone/Fax

Practice location:
  • Phone: 920-207-5499
  • Fax: 920-306-8504
Mailing address:
  • Phone: 920-802-2100
  • Fax: 920-306-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD-43783
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number82353-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD-22041
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: