Individual
DR. CARLO R. LAZZARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7272
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01062010
IN
2085R0202X
Diagnostic Radiology Physician
Primary
4301078104
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200822810
—
IN
Enumeration date
06/05/2006
Last updated
01/21/2025
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