Provider Demographics
NPI:1528007366
Name:LAWSON, KEVIN JON (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JON
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 1:4677 TOWNE CENTRE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2846
Mailing Address - Country:US
Mailing Address - Phone:989-790-6719
Mailing Address - Fax:989-790-9464
Practice Address - Street 1:4677 TOWNE CENTRE RD FL 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2846
Practice Address - Country:US
Practice Address - Phone:989-790-6719
Practice Address - Fax:989-790-9464
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079319207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1528007366Medicaid
MIA17591Medicare UPIN
MI2001701391OtherBLUE CROSS
MI68042850OtherAETNA
MIP31540001Medicare PIN
MI680428520OtherPPOM
MI680428520OtherCIGNA
MIA17591Medicare UPIN