MEDICARE: LAUREN BLADE PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1932908217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BLADE PA-C

Provider Business Mailing Address
First Line	:	25 N WINFIELD RD STE 2202
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-307-7799
Fax Number	:	630-307-2277

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD STE 2202
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-307-7799
Fax Number	:	630-307-2277

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	12/09/2025

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Directions to “ LAUREN BLADE PA-C” Practice Location

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