Provider Demographics
NPI:1710121371
Name:LACKERMANN, SARAH CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CHRISTINE
Last Name:LACKERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-3834
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS ST STE 595
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3011
Practice Address - Country:US
Practice Address - Phone:317-688-5626
Practice Address - Fax:317-688-5627
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099847207Q00000X
KY47197207Q00000X
IN01078451A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201250360Medicaid
KYK151920Medicare PIN