Provider Demographics
NPI:1902997786
Name:SPOLJARIC, LAWRENCE JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:SPOLJARIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 LEATHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9236
Mailing Address - Country:US
Mailing Address - Phone:330-335-1551
Mailing Address - Fax:330-335-1552
Practice Address - Street 1:251 LEATHERMAN RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9236
Practice Address - Country:US
Practice Address - Phone:330-335-1551
Practice Address - Fax:330-335-1552
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309562Medicaid
OH0309562Medicaid
A74907Medicare UPIN