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NPI Code Detail

MEDICARE: DR. KEITH LANIER BLACK M.D.

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
1174400000XSpecialistG60334CA

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 : PO BOX 512717
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-0717
Country : US
Telephone Number : 310-967-1884
Fax Number : 310-967-1744
Provider Business Practice Location Address
First Line : 8700 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-1865
Country : US
Telephone Number : 310-967-1884
Fax Number : 310-967-1744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 07/08/2007

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Directions to “ DR. KEITH LANIER BLACK M.D.” Practice Location

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