Healthcare Provider Details

I. General information

NPI: 1417981770
Provider Name (Legal Business Name): LAWRENCE KONST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20433 HICKORY LN
LIVONIA MI
48152-1007
US

IV. Provider business mailing address

20433 HICKORY LN
LIVONIA MI
48152-1007
US

V. Phone/Fax

Practice location:
  • Phone: 248-390-8311
  • Fax:
Mailing address:
  • Phone: 248-390-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLK015341
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: