Provider Demographics
NPI:1396364576
Name:GARSIDE, LAUREN MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELLE
Last Name:GARSIDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W RAND RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1157
Mailing Address - Country:US
Mailing Address - Phone:847-618-5450
Mailing Address - Fax:847-618-9695
Practice Address - Street 1:199 W RAND RD STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1157
Practice Address - Country:US
Practice Address - Phone:847-618-5450
Practice Address - Fax:847-618-5459
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085007506OtherSTATE LICENSE