Provider Demographics
NPI:1790923241
Name:FINE, LAUREN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ANN
Last Name:FINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SUPERIOR ST UNIT 1012
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8137
Mailing Address - Country:US
Mailing Address - Phone:847-275-3479
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST STE 701
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5196
Practice Address - Country:US
Practice Address - Phone:773-572-5796
Practice Address - Fax:773-572-5024
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.125993207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-125993Medicaid
ILIL2485017Medicare PIN