Provider Demographics
NPI:1669464731
Name:LAWRENCE, KRISTEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:S
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 428
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-672-3300
Practice Address - Fax:231-672-3380
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301079214207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1763030OtherMEDICARE PTAN
MIMI4162002OtherMEDICARE PTAN
MIP114288OtherBCN/BLUE CHOICE
MIN42130035OtherMEDICARE PTAN
MIMI1763030OtherMEDICARE PTAN
MI700F110460OtherBLUE CARE NETWORK
MI160F112760OtherBLUE CROSS BLUE SHIELD
MI700F110460OtherBLUE CROSS BLUE SHIELD
MI4989864Medicaid