Provider Demographics
NPI:1538367099
Name:MOORE, LAUREN J (MD)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7400 W RAWSON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-409-1000
Mailing Address - Fax:414-409-1019
Practice Address - Street 1:7400 W RAWSON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-409-1000
Practice Address - Fax:414-409-1019
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI50458207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI017550018OtherMEDICARE
WI70042100Medicaid