Provider Demographics
NPI:1073690798
Name:MILLER, LAWRENCE STUART (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STUART
Last Name:MILLER
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 1:145 S BURLINGAME AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2641
Mailing Address - Country:US
Mailing Address - Phone:310-319-2619
Mailing Address - Fax:310-319-2619
Practice Address - Street 1:450 N BEDFORD DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4324
Practice Address - Country:US
Practice Address - Phone:310-319-2619
Practice Address - Fax:310-319-2619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28978225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28978OtherLICENSE
CAWG28978BMedicare ID - Type UnspecifiedMEDICARE PROV NUMBER
CAG28978OtherLICENSE