Individual
LAWRENCE KNEEZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3400
Mailing address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-3311
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036055643
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL2613
MEDICARE GROUP PTAN
IL
Enumeration date
07/12/2006
Last updated
11/17/2009
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