NPI Code Detail JSON Logo

1124393228 NPI number — LARA SPERANZA LAZARRE RIES M.D.

NPI Number: 1124393228
Health Care Provider/Practitioner: LARA SPERANZA LAZARRE RIES M.D.

Information about “1124393228” NPI (LARA SPERANZA LAZARRE RIES M.D.) exists in 1124393228 in HTML format HTML  |  1124393228 in plain Text format TXT  |  1124393228 in PDF (Portable Document Format) PDF  |  1124393228 in an XML format XML  formats.

NPI Number : 1124393228 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124393228",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RIES",
    "FirstName": "LARA",
    "MiddleName": "SPERANZA LAZARRE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LAZARRE",
    "OtherFirstName": "LARA",
    "OtherMiddleName": "S",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "220 S BUSINESS PARK DR STE A6",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OOSTBURG",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53070-1586",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-802-2100",
    "MailingAddressFaxNumber": "920-306-8504",
    "FirstLinePracticeLocationAddress": "220 S BUSINESS PARK DR STE A6",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OOSTBURG",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53070-1586",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-207-5499",
    "PracticeLocationAddressFaxNumber": "920-306-8504",
    "EnumerationDate": "03/21/2012",
    "LastUpdateDate": "11/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "MD-43783",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "82353-20",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "MD-22041",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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