Provider Demographics
NPI:1952464190
Name:CIESEMIER, LAWRENCE LESTER (DO)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:LESTER
Last Name:CIESEMIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2477
Mailing Address - Country:US
Mailing Address - Phone:660-627-2553
Mailing Address - Fax:660-665-0448
Practice Address - Street 1:610 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2477
Practice Address - Country:US
Practice Address - Phone:660-627-2553
Practice Address - Fax:660-665-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114081207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244792024Medicaid
MOG89633Medicare UPIN
MO001014751Medicare ID - Type Unspecified