Healthcare Provider Details

I. General information

NPI: 1750378758
Provider Name (Legal Business Name): CYNTHIA LOCKERD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SISTER MARIE PAUL LOCKERD DO

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N HIGH ST
LANSING MI
48906-4529
US

IV. Provider business mailing address

803 4TH ST
JACKSON MN
56143-1056
US

V. Phone/Fax

Practice location:
  • Phone: 517-371-1700
  • Fax: 517-371-4245
Mailing address:
  • Phone: 507-847-3571
  • Fax: 507-847-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011388
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35741
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: