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General NPI Number Information
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NPI Number | 1033315346
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Entity Type | Organization
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Legal Business Name | MARK A LAZAR DPM PC
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Dates
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Enumeration Date | 06/23/2007
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 720 FRY RD STE. A
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City | GREENWOOD
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State | IN
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Zip | 46142-2410
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Country | US
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Telephone | 317-881-0788
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Fax | 317-889-0775
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Provider Business Mailing Address
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Address Line | 720 FRY RD STE. A
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City | GREENWOOD
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State | IN
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Zip | 46142-2410
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Country | US
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Telephone | 317-881-0788
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Fax | 317-889-0775
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK A LAZAR
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Credential | DPM
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Telephone | 317-881-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07000591
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License Number State | IN
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