Provider Demographics
NPI:1407895568
Name:LACKIE, STEVEN L (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:L
Last Name:LACKIE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:4677 TOWNE CENTRE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2846
Mailing Address - Country:US
Mailing Address - Phone:989-799-8712
Mailing Address - Fax:989-791-4216
Practice Address - Street 1:4677 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2846
Practice Address - Country:US
Practice Address - Phone:989-799-8712
Practice Address - Fax:989-791-4216
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI001993363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical