MEDICARE: DENISE K LAUTENBACH MD

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	207R00000X	Internal Medicine Physician	039966	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174620694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE K LAUTENBACH MD

Provider Business Mailing Address
First Line	:	761 MAIN AVE
Second Line	:	STE 201
City	:	NORWALK
State	:	CT
Zip	:	06851-1080
Country	:	US
Telephone Number	:	203-838-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	194 SOUTH AVE
Second Line	:
City	:	NEW CANAAN
State	:	CT
Zip	:	06840-5728
Country	:	US
Telephone Number	:	203-966-8079
Fax Number	:	203-966-8223

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

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	01/07/2020

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