Provider Demographics
NPI:1073697199
Name:KAWA, LANA (MD)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:KAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:KOUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4965 ADAMS PIONTE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4111
Mailing Address - Country:US
Mailing Address - Phone:586-979-5100
Mailing Address - Fax:586-795-5050
Practice Address - Street 1:37450 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3503
Practice Address - Country:US
Practice Address - Phone:586-979-5100
Practice Address - Fax:586-795-5050
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110B510530OtherBCBSM
MI1021087OtherMHP HAN
MI4928742Medicaid
MI01004037OtherHEALTH PLUS
MI17889OtherMCARE
MIOM28450057Medicare ID - Type Unspecified
MI110B510530OtherBCBSM