Provider Demographics
NPI:1528044161
Name:LAWSON, TINA M (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:WALLS
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2330 S DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6411
Mailing Address - Country:US
Mailing Address - Phone:765-455-5400
Mailing Address - Fax:765-865-3710
Practice Address - Street 1:2330 S DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6411
Practice Address - Country:US
Practice Address - Phone:765-455-5400
Practice Address - Fax:765-865-3710
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044162A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200009320Medicaid
IN3937240023OtherMEDICAREDMEPOS
INP00315370OtherRAILROAD MEDICARE
IN000000368345OtherANTHEM
IN7907OtherPHYSICIANS HEALTH PLAN
IN069860RRRMedicare UPIN
IN069920KMedicare PIN
IN200009320Medicaid