Healthcare Provider Details

I. General information

NPI: 1053410704
Provider Name (Legal Business Name): JOHN LAURAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 PARKDALE PL STE D
INDIANAPOLIS IN
46254-4697
US

IV. Provider business mailing address

2016 NORTHAMPTON WAY
LANSING MI
48912-3528
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-7373
  • Fax: 317-415-7310
Mailing address:
  • Phone: 517-244-9170
  • Fax: 517-244-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJL053504
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: