Provider Demographics
NPI:1164453601
Name:OSWALD, LAURA A (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:OSWALD
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 1:7 BLANCHARD CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2039
Mailing Address - Country:US
Mailing Address - Phone:630-510-9009
Mailing Address - Fax:630-510-0152
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2039
Practice Address - Country:US
Practice Address - Phone:630-510-9009
Practice Address - Fax:630-510-0152
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL98989OtherMEDICARE PTAN (INDIVIDUAL)
IL0222075OtherBLUE CROSS GROUP NUMBER
IL920540OtherMEDICARE PTAN (GROUP)
IL036108633Medicaid
IL0222075OtherBLUE CROSS GROUP NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID