Provider Demographics
NPI:1841290301
Name:SANCHEZ, LAWRENCE D (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:SANCHEZ
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 1:8410 S 575 W
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46160-8492
Mailing Address - Country:US
Mailing Address - Phone:414-640-4945
Mailing Address - Fax:
Practice Address - Street 1:2040 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1017
Practice Address - Country:US
Practice Address - Phone:507-836-6153
Practice Address - Fax:507-836-8787
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN76316207Q00000X
WI41458207Q00000X
IN01074437A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841290301Medicaid
IN300011519Medicaid
MN76316OtherMINNESOTA STATE LICENSE
IN01074437AOtherIN STATE LICENSE NUMBER