Provider Demographics
NPI:1386762714
Name:ALLEN, LAURA S (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:S
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1686
Mailing Address - Country:US
Mailing Address - Phone:855-227-4230
Mailing Address - Fax:812-926-1668
Practice Address - Street 1:204 BRIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1334
Practice Address - Country:US
Practice Address - Phone:855-227-4230
Practice Address - Fax:812-926-1668
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33692207Q00000X
IN01076279A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64336928Medicaid
OH2081483Medicaid
OH2081483Medicaid
KY0307648Medicare PIN
KY0351447Medicare PIN
KY0632943Medicare PIN
KY0586620Medicare PIN
KY3400332Medicare PIN
KY64336928Medicaid