=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790572444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN DELAND DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 N EAST AVE
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-916-1601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8200 IRISH MIST
-----------------------------------------------------
City | ONSTED
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49265-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-513-1963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 5315257992
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------