Provider Demographics
NPI:1811556137
Name:LOCKHART, KAYLA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELLE
Last Name:LOCKHART
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 1:217 GOLDEN GATE PLZ
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2881
Mailing Address - Country:US
Mailing Address - Phone:419-891-6221
Mailing Address - Fax:419-893-3394
Practice Address - Street 1:217 GOLDEN GATE PLZ
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2881
Practice Address - Country:US
Practice Address - Phone:419-891-6221
Practice Address - Fax:419-893-3394
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEMC0002961208000000X
OH57.248363390200000X
OH35.145216208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program