Provider Demographics
NPI:1477521979
Name:SENOL, LAURIE D (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:SENOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:456 N NEW BALLAS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6842
Mailing Address - Country:US
Mailing Address - Phone:314-646-7015
Mailing Address - Fax:314-646-7016
Practice Address - Street 1:456 N NEW BALLAS RD STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6842
Practice Address - Country:US
Practice Address - Phone:314-646-6015
Practice Address - Fax:314-646-7016
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO105953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44684Medicare UPIN