Provider Demographics
NPI:1891964557
Name:DAVID W LAW DO PC
Entity Type:Organization
Organization Name:DAVID W LAW DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-676-4040
Mailing Address - Street 1:2128 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5470
Mailing Address - Country:US
Mailing Address - Phone:734-676-4040
Mailing Address - Fax:734-676-9897
Practice Address - Street 1:2128 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-5470
Practice Address - Country:US
Practice Address - Phone:734-676-4040
Practice Address - Fax:734-676-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007204208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111376298Medicaid
MIE25707Medicare UPIN
MI111376298Medicaid