Healthcare Provider Details

I. General information

NPI: 1083307441
Provider Name (Legal Business Name): LAUREN LUCAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 WISHARD BLVD
INDIANAPOLIS IN
46202-2872
US

IV. Provider business mailing address

5359 W FULLERTON AVE
CHICAGO IL
60639-1450
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-1090
  • Fax:
Mailing address:
  • Phone: 773-836-2785
  • Fax: 773-836-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125081689
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11023978A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: