Provider Demographics
NPI:1538183868
Name:LAZAR, DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:LAZAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1721
Mailing Address - Country:US
Mailing Address - Phone:248-967-3668
Mailing Address - Fax:248-967-0630
Practice Address - Street 1:5160 EAGLE LAKE DR
Practice Address - Street 2:
Practice Address - City:WATERFORD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48329-1721
Practice Address - Country:US
Practice Address - Phone:248-967-3668
Practice Address - Fax:248-967-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4856351260213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00067283OtherMEDICARE RAILROAD INSURAN
MI1502974Medicaid
MI1502974Medicaid
MIP00067283OtherMEDICARE RAILROAD INSURAN
MIP00067283OtherMEDICARE RAILROAD INSURAN