Provider Demographics
NPI:1407801574
Name:KERN, LAUREN RAUCH (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAUCH
Last Name:KERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:122 S. MICHIGAN AVE
Mailing Address - Street 2:SUITE 1317
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6191
Mailing Address - Country:US
Mailing Address - Phone:312-922-3882
Mailing Address - Fax:312-922-5656
Practice Address - Street 1:122 S. MICHIGAN AVE
Practice Address - Street 2:SUITE 1317
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-922-3882
Practice Address - Fax:312-922-5656
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036071902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
31602903OtherBLUE CROSS
IL905720Medicare UPIN