MEDICARE: DR. KAREN KAY LACY M.D.

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	207Q00000X	Family Medicine Physician	35057134L	OH

General Provider Information

NPI Number	:	1417145053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN KAY LACY M.D.

Provider Business Mailing Address
First Line	:	4623 WESLEY AVE STE P
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	513-841-0777
Fax Number	:	513-841-0877

Provider Business Practice Location Address
First Line	:	4623 WESLEY AVE STE P
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	513-841-0777
Fax Number	:	513-841-0877

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	02/13/2013

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