Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036-097662 | IL |
Y | 208600000X | Surgeon | 036-097662 | IL |
N | 2086X0206X | Surgical Oncologist | 036-097662 | IL |
NPI | 1235288416 |
---|---|
Provider Name | Dr. Gianluca Lazzaro |
First Address | Chicago, IL 60611-1157 |
Second Address | Chicago, IL 60611-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01615715 | BLUE CROSS BLUE SHIELD (01) | IL |