Provider Demographics
NPI:1265450456
Name:WALNY, LAWRENCE L (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:WALNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2432 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8069
Mailing Address - Country:US
Mailing Address - Phone:810-606-6499
Mailing Address - Fax:810-606-7245
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:810-606-6499
Practice Address - Fax:810-606-7245
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042284208VP0014X, 207L00000X
IAMD-50984207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3044804-10Medicaid