Provider Demographics
NPI:1063827053
Name:STOFFEL, LAUREN JUNE (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JUNE
Last Name:STOFFEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 W LUDWIG RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-1328
Mailing Address - Country:US
Mailing Address - Phone:260-755-1304
Mailing Address - Fax:260-755-1306
Practice Address - Street 1:2932 W LUDWIG RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1328
Practice Address - Country:US
Practice Address - Phone:260-755-1304
Practice Address - Fax:260-755-1306
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012859207Q00000X
IN11017942A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine