Provider Demographics
NPI:1780887612
Name:DAWSON, LAUREN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ANN
Last Name:DAWSON
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 1:4944 CUMNOR RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3939
Mailing Address - Country:US
Mailing Address - Phone:317-694-4115
Mailing Address - Fax:
Practice Address - Street 1:4944 CUMNOR RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3939
Practice Address - Country:US
Practice Address - Phone:317-694-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060967A207P00000X
IL036.118950207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118950OtherBLUE SHIELD
IL036118950-2Medicaid
IL036118950Medicaid
IL036118950-1Medicaid
IL036118950-1Medicaid
IL036118950-2Medicaid