Provider Demographics
NPI:1144418914
Name:CERULLO, LAUREN ELISABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELISABETH
Last Name:CERULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9200 CALUMET AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2885
Mailing Address - Country:US
Mailing Address - Phone:219-228-4200
Mailing Address - Fax:844-965-9457
Practice Address - Street 1:9200 CALUMET AVE
Practice Address - Street 2:STE 203
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:219-228-4200
Practice Address - Fax:844-965-9457
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066538B207N00000X
CAA97206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology