Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 70547-20 | WI |
NPI | 1003347451 |
---|---|
Provider Name | Anthony Lazaro |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Plymouth, WI 53073-5020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2017 |
Last Update Date | 19/11/2021 |