Provider Demographics
NPI:1750378758
Name:LOCKERD, CYNTHIA (DO)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LOCKERD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SISTER MARIE PAUL
Other - Middle Name:
Other - Last Name:LOCKERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:803 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1056
Mailing Address - Country:US
Mailing Address - Phone:507-847-3571
Mailing Address - Fax:507-847-5664
Practice Address - Street 1:1717 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4529
Practice Address - Country:US
Practice Address - Phone:517-371-1700
Practice Address - Fax:517-371-4245
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011388207Q00000X
MN35741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA2081015126OtherPREFERRED ONE
MI700B960280OtherBCBS
MI1750378758Medicaid
0115319OtherMEDICA
111661OtherUCARE MINNESOTA
MN791590000Medicaid
MI1063376OtherMCLAREN HEALTH PLAN
MN2M018LOOtherBCBS MINNESOTA
120002169OtherPALMETTO GBA RR MEDICARE
21394OtherSIOUX VALLEY HEALTH PLAN
111661OtherUCARE MINNESOTA
0115319OtherMEDICA