Provider Demographics
NPI:1841372455
Name:LACEY, STEFFAN RODMAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFFAN
Middle Name:RODMAN
Last Name:LACEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5440 SOUTH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-465-1900
Mailing Address - Fax:402-465-1940
Practice Address - Street 1:109 N 15TH STREET
Practice Address - Street 2:SUITE 36
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-371-3322
Practice Address - Fax:402-371-3771
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-06-03
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Provider Licenses
StateLicense IDTaxonomies
NE13421207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE88521Medicare PIN