MEDICARE: LAWRENCE H RESNICK MD A PROF CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ64205Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1578595161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE H RESNICK MD A PROF CORP

Provider Business Mailing Address
First Line	:	15335 MORRISON ST
Second Line	:	SUITE 304
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1513
Country	:	US
Telephone Number	:	818-528-3466
Fax Number	:	818-528-3464

Provider Business Practice Location Address
First Line	:	15335 MORRISON ST
Second Line	:	SUITE 304
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1513
Country	:	US
Telephone Number	:	818-528-3466
Fax Number	:	818-528-3464

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE H RESNICK
Credential	:	M.D.
Telephone Number	:	818-528-3466

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/23/2014

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