Healthcare Provider Details

I. General information

NPI: 1699339739
Provider Name (Legal Business Name): LAUREN ALEXANDRA CONNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ALEXANDRA FORD MD

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S EAST ST STE C
INDIANAPOLIS IN
46227-1991
US

IV. Provider business mailing address

14 TRAFALGAR SQ
TRAFALGAR IN
46181-9515
US

V. Phone/Fax

Practice location:
  • Phone: 317-534-4660
  • Fax: 317-782-4301
Mailing address:
  • Phone: 317-680-9103
  • Fax: 317-878-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01088285A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: