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General NPI Number Information
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NPI Number | 1790834067
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Entity Type | Individual
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Provider Name | LAZARO DAVID MIRKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ONE CHILDREN'S PLAZA
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City | DAYTON
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State | OH
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Zip | 45404-1815
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Country | US
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Telephone | 937-641-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 8890 WINTON HILLS CT
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City | SPRINGBORO
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State | OH
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Zip | 45066-9620
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Country | US
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Telephone | 937-748-0809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35055097
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License Number State | OH
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