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General NPI Number Information
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NPI Number | 1033982111
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Entity Type | Individual
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Provider Name | LAUREN ELIZABETH RADEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 36700 FIVE MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-1900
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Country | US
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Telephone | 734-335-8601
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Fax | 734-469-4237
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Provider Business Mailing Address
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Address Line | 36700 FIVE MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-1900
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Country | US
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Telephone | 734-335-8601
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Fax | 734-469-4237
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601013759
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License Number State | MI
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