Provider Demographics
NPI:1164465258
Name:KEAN B LAWLOR, MD, PLLC
Entity Type:Organization
Organization Name:KEAN B LAWLOR, MD, PLLC
Other - Org Name:SEATTLE SKIN AND LASER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HEUPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-486-2340
Mailing Address - Street 1:22833 BOTHELL EVERETT HWY
Mailing Address - Street 2:STE 201
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9385
Mailing Address - Country:US
Mailing Address - Phone:425-486-2340
Mailing Address - Fax:425-483-8135
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:STE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-525-1168
Practice Address - Fax:206-525-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128085Medicaid
WA7128085Medicaid