MEDICARE: EVANGELIA LEA LAZARIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301509229	MI
2	207V00000X	Obstetrics & Gynecology Physician	11901355-1205	UT
3	207VG0400X	Gynecology Physician	A202946	CA

General Provider Information

NPI Number	:	1003376831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELIA LEA LAZARIS MD

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 S BASCOM AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2603
Country	:	US
Telephone Number	:	408-885-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	12/12/2025

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