Provider Demographics
NPI:1396910774
Name:GEORGE LAWLEY, DO, PC
Entity type:Organization
Organization Name:GEORGE LAWLEY, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-442-4901
Mailing Address - Street 1:18306 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-5007
Mailing Address - Country:US
Mailing Address - Phone:248-442-4901
Mailing Address - Fax:248-477-8356
Practice Address - Street 1:18306 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5007
Practice Address - Country:US
Practice Address - Phone:248-442-4901
Practice Address - Fax:248-477-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208D00000X208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0158209964OtherBCN
MI0158209964OtherBCBSM
MI014794548OtherRAILROAD MEDICARE
MI322941OtherPRIORITY HEALTH
MI112775OtherCARE CHOICES
MI5820996OtherUMWA HEALTH & RETIREMENT
MIP55910001Medicare PIN
MI0P55910Medicare PIN
MI322941OtherPRIORITY HEALTH