Individual
LAUREN STAVROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4008 W BETHEL AVE, MUNCIE, IN 47304-5442
(765) 298-4750
(765) 286-0185
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002888A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300033860
—
IN
Enumeration date
12/28/2019
Last updated
11/27/2023
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