Provider Demographics
NPI:1053411736
Name:LAZAR, CORINA (MD)
Entity type:Individual
Prefix:DR
First Name:CORINA
Middle Name:
Last Name:LAZAR
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Gender:F
Credentials:MD
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Mailing Address - Street 1:20300 CIVIC CENTER DRIVE
Mailing Address - Street 2:STE. 303
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4169
Mailing Address - Country:US
Mailing Address - Phone:248-559-8190
Mailing Address - Fax:248-559-8776
Practice Address - Street 1:200 DIVERSION ST.
Practice Address - Street 2:STE. 10 A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-559-8190
Practice Address - Fax:248-559-8776
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2012-05-08
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Provider Licenses
StateLicense IDTaxonomies
MI43010683132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH29319Medicare UPIN