MEDICARE: OLGA LACKI MD

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	2080S0012X	Pediatric Sleep Medicine Physician	105046	GA

General Provider Information

NPI Number	:	1407597701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA LACKI MD

Provider Business Mailing Address
First Line	:	705 RILEY HOSPITAL DR., RI-5837
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202
Country	:	US
Telephone Number	:	317-944-4034
Fax Number	:

Provider Business Practice Location Address
First Line	:	2174 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3102
Country	:	US
Telephone Number	:	412-610-6233
Fax Number	:

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

Provider Enumeration Date	:	04/02/2022
Last Update Date	:	05/08/2026

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