Provider Demographics
NPI:1831132869
Name:LAWLOR, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:LAWLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-170
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-5060
Mailing Address - Fax:269-381-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-170
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-5060
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301057428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110C910470OtherBCBS GRP PIN
115407OtherGREAT LAKES HLTH PLN
MI1103962242OtherBCBS IND PIN
5453200OtherAETNA PIN
MI3489218-10Medicaid
MI1831132869Medicaid
115407OtherGREAT LAKES HLTH PLN
MIC97618265Medicare PIN
MI3489218-10Medicaid
115407OtherGREAT LAKES HLTH PLN
MI1831132869Medicaid
MICI6212Medicare PIN