Healthcare Provider Details

I. General information

NPI: 1487649315
Provider Name (Legal Business Name): LAUREN HOLINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E. CHICAGO AVE., #25 ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
CHICAGO IL
60611-2605
US

IV. Provider business mailing address

225 E. CHICAGO AVE., #25 ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
CHICAGO IL
60611-2605
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6230
  • Fax:
Mailing address:
  • Phone: 312-227-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number036-050844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: