=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508117219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANK D LAZZERINI MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2012
-----------------------------------------------------
Last Update Date | 02/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7452 FULTON DR NW
-----------------------------------------------------
City | MASSILLON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44646-9393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-830-6211
-----------------------------------------------------
Fax | 330-830-6212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7452 FULTON DR NW
-----------------------------------------------------
City | MASSILLON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44646-9393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-830-6211
-----------------------------------------------------
Fax | 330-830-6212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. FRANK D LAZZERINI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 330-603-3893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35092741
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------