Basic Information
| Provider Information | |||||||||
| NPI: | 1720061328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAZAR | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | G3230 BEECHER RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103425656 | ||||||||
| FaxNumber: | 8103425600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301057348 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0802525141 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | C39417 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | C39417 | 01 | MI | HAP | OTHER | 4301057348 | 01 | MI | HEALTHPLUS | OTHER | 010B56026 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 010B56026 | 01 | MI | COMMUNITY BLUE PPO | OTHER | 1528 | 01 | MI | MCARE | OTHER | 3140103 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 3140103 | 05 | MI | MEDICAID | 6883683006 | 01 | MI | CIGNA | OTHER | 010B56026 | 01 | MI | BLUE CARE NETWORK | OTHER | 3047029 | 05 | MI | MEDICAID | 010B56026 | 01 | MI | BLUE CHOICE | OTHER | 3140103 | 01 | MI | HEALTH ADVANTAGE | OTHER | 4294644 | 01 | MI | AETNA | OTHER |