Healthcare Provider Details

I. General information

NPI: 1831719970
Provider Name (Legal Business Name): LAUREN OFFERLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-8614
US

IV. Provider business mailing address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-7140
  • Fax:
Mailing address:
  • Phone: 614-332-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number35.150975
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4351046890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: