MEDICARE: MR. MAZHAR H LAKHO 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	207R00000X	Internal Medicine Physician	036079702	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1811997380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAZHAR H LAKHO MD

Provider Business Mailing Address
First Line	:	5032 NORTH ILLINOIS
Second Line	:	SUITE A
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208
Country	:	US
Telephone Number	:	618-235-8720
Fax Number	:	618-235-8725

Provider Business Practice Location Address
First Line	:	5032 NORTH ILLINOIS
Second Line	:	SUITE A
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208
Country	:	US
Telephone Number	:	618-235-8720
Fax Number	:	618-235-8725

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	06/07/2019

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