Provider Demographics
NPI:1144599143
Name:ROBERT LACKAMP, MD, PC
Entity Type:Organization
Organization Name:ROBERT LACKAMP, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-262-7456
Mailing Address - Street 1:606 N LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4025
Mailing Address - Country:US
Mailing Address - Phone:816-262-7456
Mailing Address - Fax:
Practice Address - Street 1:606 N LEONARD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4025
Practice Address - Country:US
Practice Address - Phone:816-262-7456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR67922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty