MEDICARE: DR. GIANLUCA LAZZARO M.D.

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	2086X0206X	Surgical Oncology Physician	036-097662	IL
2	208600000X	Surgery Physician	036097662	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01615715	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1235288416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIANLUCA LAZZARO M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 N CALIFORNIA AVE STE 560
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2577
Country	:	US
Telephone Number	:	312-480-1945
Fax Number	:	773-293-8879

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	05/19/2026

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