Icor LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ICOR LLC

Practice address

5926 N Santa Monica Blvd
Milwaukee, WI 53217-4618

Phone

(773) 715-8034

NPI assigned

Feb 18, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ludmil Lazarov, MD

Title

Owner

Phone

(773) 715-8034

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1649863986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5926 N SANTA MONICA BLVD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5926 N SANTA MONICA BLVD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174618",
            "telephone_number": "773-715-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "LAZAROV",
        "authorized_official_first_name": "LUDMIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-715-8034",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.