Basic Information
Provider Information
NPI: 1427229558
EntityType: 2
ReplacementNPI:  
OrganizationName: CHRISTYNE LAWSON MD PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 30400 TELEGRAPH RD
Address2: SUITE 350
City: BINGHAM FARMS
State: MI
PostalCode: 480254537
CountryCode: US
TelephoneNumber: 2483539460
FaxNumber: 2483538084
Practice Location
Address1: 30400 TELEGRAPH RD
Address2: SUITE 350
City: BINGHAM FARMS
State: MI
PostalCode: 480254537
CountryCode: US
TelephoneNumber: 2483539460
FaxNumber: 2483538084
Other Information
ProviderEnumerationDate: 03/17/2008
LastUpdateDate: 09/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: VALVONA
AuthorizedOfficialFirstName: NANCY
AuthorizedOfficialMiddleName: B
AuthorizedOfficialTitleorPosition: PRACTICE MANAGER
AuthorizedOfficialTelephone: 2483539460
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XCL064439MIY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
080636488101MIBCBSMOTHER
340535205MI MEDICAID
080636488101MIBCNOTHER
080632842201MIBCBSMOTHER
080F35734001MIBCBSMOTHER
080632842201MIBLUE CARE NETWORKOTHER


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