Provider Demographics
NPI:1154882389
Name:WICHELMANN, LAUREN JANE (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JANE
Last Name:WICHELMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:JANE
Other - Last Name:MUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:19000 ST JOES PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1477
Mailing Address - Country:US
Mailing Address - Phone:734-655-8250
Mailing Address - Fax:
Practice Address - Street 1:19000 ST JOES PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1477
Practice Address - Country:US
Practice Address - Phone:734-655-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101027582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology