Individual
LAUREN NICOLE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
30795 23 MILE RD STE 201, CHESTERFIELD, MI 48047-5721
(586) 421-1600
(586) 421-2002
Mailing address
PO BOX 675398, DETROIT, MI 48267-5398
(586) 329-1880
(586) 231-0055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05240
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205499910
—
MI
01
—
MI16311021
MEDICARE HFPP
MI
Enumeration date
04/18/2019
Last updated
01/11/2023
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