Provider Demographics
NPI:1417145053
Name:LACY, KAREN KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:KAY
Last Name:LACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:KAY
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4623 WESLEY AVE STE P
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2272
Mailing Address - Country:US
Mailing Address - Phone:513-841-0777
Mailing Address - Fax:513-841-0877
Practice Address - Street 1:4623 WESLEY AVE STE P
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2272
Practice Address - Country:US
Practice Address - Phone:513-841-0777
Practice Address - Fax:513-841-0877
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057134L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine