Provider Demographics
NPI:1083242630
Name:LAWLESS, MARIJA KAY (MD)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:KAY
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIJA
Other - Middle Name:KAY
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24883 US HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8158
Mailing Address - Country:US
Mailing Address - Phone:785-364-2126
Mailing Address - Fax:
Practice Address - Street 1:1110 COLUMBINE DR STE 100
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8824
Practice Address - Country:US
Practice Address - Phone:785-364-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-48243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine