Provider Demographics
NPI:1831150770
Name:LAZAR, ROBERT J (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1115 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3258
Mailing Address - Country:US
Mailing Address - Phone:231-995-3657
Mailing Address - Fax:231-995-3658
Practice Address - Street 1:1115 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3258
Practice Address - Country:US
Practice Address - Phone:231-995-3657
Practice Address - Fax:231-995-3658
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050475207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110235925OtherRAILROAD MEDICARE
MI102519OtherPREFERED CHOICE
MI0280257OtherBCBS OF MICHIGAN
MI2843379Medicaid
MI0280257OtherBCBS OF MICHIGAN
MIA78044Medicare UPIN