Individual
DR. JAKE LAZAROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE # MC5067, CHICAGO, IL 60637-1443
(773) 702-0549
Mailing address
PO BOX 953593, SAINT LOUIS, MO 63195-3593
(847) 570-4789
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
125074787
IL
207N00000X
Dermatology Physician
Primary
2024012056
MO
207ND0101X
MOHS-Micrographic Surgery Physician
2024012056
MO
207R00000X
Internal Medicine Physician
125074787
IL
Other
Enumeration date
11/21/2015
Last updated
07/26/2024
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