Provider Demographics
NPI:1063522506
Name:LAWSON, CHRISTYNE ELLA (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTYNE
Middle Name:ELLA
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:611 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2273
Mailing Address - Country:US
Mailing Address - Phone:313-832-6300
Mailing Address - Fax:313-832-2075
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:248-353-9460
Practice Address - Fax:248-353-8084
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080F01470OtherBCBS
MI1045051380Medicaid
MI080F01470OtherBCBS
MI0N71120Medicare ID - Type Unspecified