Healthcare Provider Details

I. General information

NPI: 1508964974
Provider Name (Legal Business Name): ROBERT D LACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7835 REMINGTON RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

7835 REMINGTON RD
CINCINNATI OH
45242
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1400
  • Fax: 513-984-3485
Mailing address:
  • Phone: 513-984-1400
  • Fax: 513-984-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35047477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: