Provider Demographics
NPI:1821230343
Name:LAUREN MICHELSEN, D.O., P.A.
Entity Type:Organization
Organization Name:LAUREN MICHELSEN, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-335-1490
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-335-1490
Mailing Address - Fax:972-335-1491
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 401
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-335-1490
Practice Address - Fax:972-335-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7045207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191459001Medicaid
TX78212278OtherAETNA
TX0065PAOtherBCBS
TXH54241Medicare UPIN