MEDICARE: LISA M LACKEY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1184942617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M LACKEY

Provider Business Mailing Address
First Line	:	5772 PEARTON CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2700
Country	:	US
Telephone Number	:	513-289-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 ENGLE RD BLDG 6-601
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-8491
Country	:	US
Telephone Number	:	216-200-7840
Fax Number	:

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

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	05/01/2025

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