=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053410704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN LAURAIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6620 PARKDALE PL STE D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-4697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-415-7373
-----------------------------------------------------
Fax | 317-415-7310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2016 NORTHAMPTON WAY
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48912-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-244-9170
-----------------------------------------------------
Fax | 517-244-9173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | JL053504
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------