Provider Demographics
NPI:1376577288
Name:LACOSTE, MARCEL (MD)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:LACOSTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 89
Mailing Address - Street 2:RURAL ROUTE 3
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-0089
Mailing Address - Country:US
Mailing Address - Phone:620-285-4576
Mailing Address - Fax:620-285-4579
Practice Address - Street 1:BOX 89
Practice Address - Street 2:RURAL ROUTE 3
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-0089
Practice Address - Country:US
Practice Address - Phone:620-285-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0800275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105455Medicare ID - Type Unspecified
G90485Medicare UPIN