Provider Demographics
NPI:1114389145
Name:HANDSHOE, LACY SAMUEL (DO)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:SAMUEL
Last Name:HANDSHOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-3616
Mailing Address - Fax:216-636-2175
Practice Address - Street 1:4915 NORTON HEALTHCARE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2860
Practice Address - Country:US
Practice Address - Phone:502-394-6460
Practice Address - Fax:502-394-6465
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY049502084N0400X, 2084V0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty