Provider Demographics
NPI:1457341505
Name:KARLOCK, LAWRENCE G (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:KARLOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SANDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7610
Mailing Address - Country:US
Mailing Address - Phone:330-792-6519
Mailing Address - Fax:330-792-9911
Practice Address - Street 1:1300 S CANFIELD NILES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4081
Practice Address - Country:US
Practice Address - Phone:330-792-6519
Practice Address - Fax:330-792-9911
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002881213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA193223OtherBCBS PA
OH000000139309OtherANTHEMBCBS
OH0152472Medicaid
OH0780153Medicare PIN
OH000000139309OtherANTHEMBCBS
OHU36983Medicare UPIN
OH0780152Medicare PIN
OH0152472Medicaid
OH0780154Medicare PIN