Provider Demographics
NPI:1457547655
Name:KEAN B. LAWLOR, MD, PLLC
Entity Type:Organization
Organization Name:KEAN B. LAWLOR, MD, PLLC
Other - Org Name:SEATTLE SKIN AND LASER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEUPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-486-2340
Mailing Address - Street 1:22833 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9385
Mailing Address - Country:US
Mailing Address - Phone:425-486-2340
Mailing Address - Fax:425-483-8135
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:206-525-1168
Practice Address - Fax:206-525-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD30728207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty