Provider Demographics
NPI:1639557085
Name:AZEVEDO, LAUREN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARIE
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 W GRAND RIVER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2394
Mailing Address - Country:US
Mailing Address - Phone:517-349-6560
Mailing Address - Fax:517-679-8232
Practice Address - Street 1:1600 W GRAND RIVER AVE STE 2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-349-6560
Practice Address - Fax:517-679-8232
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics