Provider Demographics
NPI:1386744076
Name:LAWSON, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 N 22ND PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2707
Mailing Address - Country:US
Mailing Address - Phone:602-743-8053
Mailing Address - Fax:602-957-3847
Practice Address - Street 1:7600 N 15TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4327
Practice Address - Country:US
Practice Address - Phone:602-331-1771
Practice Address - Fax:602-331-1773
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8069207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE45429Medicare UPIN
AZ30WCFGD17Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER