Provider Demographics
NPI:1275551590
Name:REYNOLDS, LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 TUURI PL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2465
Mailing Address - Country:US
Mailing Address - Phone:810-767-5750
Mailing Address - Fax:810-768-7511
Practice Address - Street 1:806 TUURI PL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2465
Practice Address - Country:US
Practice Address - Phone:810-767-5750
Practice Address - Fax:810-768-7511
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2713937Medicaid
MI2713937Medicaid
MIA77281Medicare UPIN