Healthcare Provider Details

I. General information

NPI: 1669508420
Provider Name (Legal Business Name): MICHAEL WILLIAM LAWLOR MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE CHILDRENS HOSPITAL OF WI
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE CHILDRENS HOSPITAL OF WI
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2526
  • Fax: 414-266-2779
Mailing address:
  • Phone: 414-266-2526
  • Fax: 414-266-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberL-221200
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number56216
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number56216
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: