MEDICARE: LAUREN RAUCH KERN 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	2084P0800X	Psychiatry Physician	03607190	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31602903	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1407801574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN RAUCH KERN MD

Provider Business Mailing Address
First Line	:	122 S. MICHIGAN AVE
Second Line	:	SUITE 1317
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-922-3882
Fax Number	:	312-922-5656

Provider Business Practice Location Address
First Line	:	122 S. MICHIGAN AVE
Second Line	:	SUITE 1317
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-922-3882
Fax Number	:	312-922-5656

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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