Provider Demographics
NPI:1669969697
Name:FILL, LAUREN (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 W 227TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1856
Mailing Address - Country:US
Mailing Address - Phone:724-944-9876
Mailing Address - Fax:
Practice Address - Street 1:25761 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3368
Practice Address - Country:US
Practice Address - Phone:440-779-1112
Practice Address - Fax:440-779-0247
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34016088207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty