# LAZ MEDICAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053310128
- **Authorized official:** DR. ZAKARI TATA MD (PHYSICIAN OWNER)
- **Authorized official phone:** (248) 569-7550

## Contact information

- **Practice address:** 20755 GREENFIELD RD, \#1101, SOUTHFIELD, MI 48075-5403
- **Practice address phone:** (248) 569-7550
- **Practice address fax:** (313) 561-0277
- **Mailing address:** PO BOX 250005, W BLOOMFIELD, MI 48325-0005
- **Mailing address phone:** (248) 569-7550
- **Mailing address fax:** (313) 561-0277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | — | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 07/20/2005
- **Last updated:** 05/06/2025