Lacey, Martin S

Lacey, Martin S is an individual health care provider with primary practice located at 640 Jackson St Mc 11503B, Saint Paul MN 55101-2502. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as his primary health care specialty. Lacey, Martin S can be contacted via phone (651) 254-3792.

Contact Information

Primary practice address
640 Jackson St Mc 11503B Saint Paul MN 55101-2502
Phone: (651) 254-3792
Fax: (651) 254-8208
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 44353 Minnesota
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 45762 Wisconsin

Profile Details

NPI number 1821064288
LBN Legal business name Lacey, Martin S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2006
Last updated Oct 23rd, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821064288 NPPES
Minnesota MEDICAID 322800200

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