Provider Demographics
NPI:1386655777
Name:KNEISLEY, LAWRENCE WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:KNEISLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23560 MADISON STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-530-8822
Mailing Address - Fax:310-530-0288
Practice Address - Street 1:23560 MADISON STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-530-8822
Practice Address - Fax:310-530-0288
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG282902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28290Medicare PIN
CAA43681Medicare UPIN