Provider Demographics
NPI:1942977343
Name:LAURUS PRACTITIONERS
Entity Type:Organization
Organization Name:LAURUS PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-835-9990
Mailing Address - Street 1:2398 SOLIDAGO DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4821
Mailing Address - Country:US
Mailing Address - Phone:317-835-9990
Mailing Address - Fax:317-268-6523
Practice Address - Street 1:2398 SOLIDAGO DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-4821
Practice Address - Country:US
Practice Address - Phone:317-835-9990
Practice Address - Fax:317-268-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty