Healthcare Provider Details

I. General information

NPI: 1306282561
Provider Name (Legal Business Name): LAUREN HENSLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 12/20/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 RAND RD
DES PLAINES IL
60016-1005
US

IV. Provider business mailing address

1875 DEMPSTER ST SUITE 330
PARK RIDGE IL
60068-1186
US

V. Phone/Fax

Practice location:
  • Phone: 847-655-8500
  • Fax:
Mailing address:
  • Phone: 847-655-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036140661
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: