MEDICARE: DR. KEITH LANIER BLACK M.D.

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	207T00000X	Neurological Surgery Physician	G60334	CA

General Provider Information

NPI Number	:	1841284460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH LANIER BLACK M.D.

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	310-423-7900
Fax Number	:	310-423-8914

Provider Business Practice Location Address
First Line	:	8700 BEVERLY BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1804
Country	:	US
Telephone Number	:	310-423-7900
Fax Number	:	310-423-8914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	05/19/2026

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