Provider Demographics
NPI:1770656449
Name:LACKEY, GERALD FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:FRANCIS
Last Name:LACKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7946 MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-1338
Mailing Address - Country:US
Mailing Address - Phone:440-729-3144
Mailing Address - Fax:
Practice Address - Street 1:7946 MULBERRY RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-1338
Practice Address - Country:US
Practice Address - Phone:440-729-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.002782207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561842Medicaid
OHLA0519852Medicare ID - Type Unspecified
OH0561842Medicaid