MEDICARE: MICHAEL LAWRENCE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1174-023	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992790505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LAWRENCE PA

Provider Business Mailing Address
First Line	:	S66W22285 NATIONAL AVE
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53189-9660
Country	:	US
Telephone Number	:	414-238-3859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4508
Country	:	US
Telephone Number	:	414-585-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/23/2021

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Directions to “ MICHAEL LAWRENCE PA” Practice Location

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