Individual
LAUREEN L AMBROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD SC
Contact information
Practice address
15300 WEST AVE, SUITE 205, ORLAND PARK, IL 60462-4600
(708) 460-1040
(708) 460-6872
Mailing address
15300 WEST AVE, SUITE 205, ORLAND PARK, IL 60462-4600
(708) 460-1040
(708) 460-6872
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-059550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31600367
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/13/2006
Last updated
04/01/2011
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