Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 036150513 | IL |
Y | 213ES0000X | Sports Medicine | 036150513 | IL |
N | 2081S0010X | Sports Medicine | 125.066107 | IL |
N | 213ES0000X | Sports Medicine | 125.066107 | IL |
NPI | 1023428786 |
---|---|
Provider Name | Lauren Splittgerber |
First Address | Oak Park, IL 60302-2519 |
Second Address | Oak Park, IL 60302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2014 |
Last Update Date | 27/12/2019 |