DR. LAURA K MANSFIELD, M.D. - NPI NUMBER 1023337995

Summary

Provider Name: DR. LAURA K MANSFIELD, M.D.

NPI Number: 1023337995

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Address:
2300 N LINCOLN AVE
CHICAGO, IL
ZIP 60614

Phone Number: (312) 503-7975



Detailed Information

DR. Laura K Mansfield, M.D. is a student in an organized health care education/training program in Chicago, IL. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1023337995 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

2300 N LINCOLN AVE
CHICAGO, IL
ZIP 60614-320
Phone: (312) 503-7975

The enumeration date for this NPI number is 5/18/2010 and was last updated on 3/12/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program NOT YET ISSUED IL Yes

NPI Record

No. Field Name Field Value
1 NPI 1023337995
2 Entity Type Code 1
3 Provider Last Name Legal Name MANSFIELD
4 Provider First Name LAURA
5 Provider Middle Name K
6 Provider Name Prefix Text DR.
7 Provider Credential Text M.D.
8 Provider First Line Business Practice Location Address 2300 N LINCOLN AVE
9 Provider Business Practice Location Address City Name CHICAGO
10 Provider Business Practice Location Address State Name IL
11 Provider Business Practice Location Address Postal Code 606143320
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 3125037975
14 Provider Enumeration Date 5/18/2010
15 Last Update Date 3/12/2012
16 Provider Gender Code F
17 Healthcare Provider Taxonomy Code 1 390200000X
18 Provider License Number 1 NOT YET ISSUED
19 Provider License Number State Code 1 IL
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Sole Proprietor Y

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.