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NPI Code Detail

MEDICARE: MS. JENNIFER ASHLEY LAZOR D.O.

MEDICARE: MS. JENNIFER ASHLEY LAZOR D.O.
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
1207R00000XInternal Medicine Physician036.136935IL
2390200000XStudent in an Organized Health Care Education/Training Program
3207RN0300XNephrology Physician34.011289OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346515871
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER ASHLEY LAZOR D.O.
Provider Business Mailing Address
First Line : 1426 W. WASHINGTON BLVD.
Second Line :
City : CHICAGO
State : IL
Zip : 60607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1426 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1821
Country : US
Telephone Number : 312-829-1424
Fax Number : 312-850-8431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2012
Last Update Date : 12/20/2017

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