Provider Demographics
NPI:1417970484
Name:WENDY B LAWTON, M.D., PLLC
Entity Type:Organization
Organization Name:WENDY B LAWTON, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-953-3690
Mailing Address - Street 1:8203 S SAGINAW ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2434
Mailing Address - Country:US
Mailing Address - Phone:810-953-3690
Mailing Address - Fax:810-953-9543
Practice Address - Street 1:8203 S SAGINAW ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2434
Practice Address - Country:US
Practice Address - Phone:810-953-3690
Practice Address - Fax:810-953-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042053208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4553251Medicaid
MI4553251Medicaid