1699759233 NPI number — DR. CIRE LAZAROSKI DC

Table of content: DR. CIRE LAZAROSKI DC (NPI 1699759233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699759233 NPI number — DR. CIRE LAZAROSKI DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZAROSKI
Provider First Name:
CIRE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699759233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1733 E 37TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46342-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-947-0016
Provider Business Mailing Address Fax Number:
219-947-5651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1733 E 37TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-947-0016
Provider Business Practice Location Address Fax Number:
219-947-5651
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001944 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000194681 . This is a "BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200293860A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 352128560 . This is a "SAGAMORE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 352128560 . This is a "HUMANA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50433 . This is a "UNIVERSAL HS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9138729 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2547571 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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