Active NPI
Jonnathan Omar Cazares Lara, M.D.
- Student in an Organized Health Care Education/Training Program
- Commerce Charter TWP, MI
National Provider Identifier
1912755232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1 William Carls Dr
Commerce Charter TWP, MI 48382 - Phone
- (248) 937-5085
- NPI assigned
- May 10, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241113003281 | MI | Order and Referring Only - Internal Medicine |
2365976354 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
1 William Carls Dr
Commerce Charter TWP, MI 48382
Mailing address
1 William Carls Dr
Commerce Charter TWP, MI 48382
Phone (248) 937-5085
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 2, 2024.
{
"created_epoch": "1715299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727827200000",
"number": "1912755232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 WILLIAM CARLS DR",
"city": "COMMERCE CHARTER TWP",
"state": "MI",
"postal_code": "48382",
"telephone_number": "248-937-5085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WILLIAM CARLS DR",
"city": "COMMERCE CHARTER TWP",
"state": "MI",
"postal_code": "48382",
"telephone_number": "248-937-5085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAZARES LARA",
"first_name": "JONNATHAN",
"middle_name": "OMAR",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-10",
"last_updated": "2024-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commerce Charter TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.