Healthcare Provider Details

I. General information

NPI: 1194307827
Provider Name (Legal Business Name): MATTHEW GEORGE LAWS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 CLEVELAND RD W
HURON OH
44839-1410
US

IV. Provider business mailing address

44 W 14TH ST
CHICAGO IL
60605-2714
US

V. Phone/Fax

Practice location:
  • Phone: 703-646-3200
  • Fax:
Mailing address:
  • Phone: 703-930-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: