MEDICARE: LAUREN JUNE STOFFEL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34.012859	OH
2	207Q00000X	Family Medicine Physician	11017942A	IN

General Provider Information

NPI Number	:	1063827053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN JUNE STOFFEL DO

Provider Business Mailing Address
First Line	:	2932 W LUDWIG RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1328
Country	:	US
Telephone Number	:	260-755-1304
Fax Number	:	260-755-1306

Provider Business Practice Location Address
First Line	:	2932 W LUDWIG RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1328
Country	:	US
Telephone Number	:	260-755-1304
Fax Number	:	260-755-1306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	03/15/2024

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