Healthcare Provider Details

I. General information

NPI: 1417417544
Provider Name (Legal Business Name): LAUREN PEREIRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN M THIESFELD DO

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVE 2ND FL
SAINT JOHN IN
46373-9487
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-226-2380
  • Fax: 219-226-2381
Mailing address:
  • Phone: 219-392-7084
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02006718A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: