Basic Information
| Provider Information | |||||||||
| NPI: | 1508823592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWS | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | FORD | ||||||||
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| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9555 76TH STREET | ||||||||
| Address2: | 4106 | ||||||||
| City: | PLEASANT PRAIRIE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531581984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626535437 | ||||||||
| FaxNumber: | 2626535850 | ||||||||
| Practice Location | |||||||||
| Address1: | 4855 S MOORLAND RD | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531517494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624327599 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 08/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 17708 | NH | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 01043200A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 042.0013318 | VT | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 66583-20 | WI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1508823592 | 05 | WI | MEDICAID | 200408090 | 05 | IN | MEDICAID | P01512415 | 01 | IN | RR MEDICARE | OTHER |