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Individual
MR. KEVIN JAMES LACEY
Active
Individual
MR. KEVIN JAMES LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070008138
IL
225100000X
Physical Therapist
Primary
5501010346
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
155764
GREATLAKES HEALTH PLAN
MI
01
—
310159700
ACS/FED GOVT
MI
01
—
6430129
IBA HEALTH PLANS
MI
01
—
650H000020
BCBS MI
MI
01
—
7993476
AETNA INS
MI
01
—
810584027
TAX ID
MI
Enumeration date
10/04/2006
Last updated
07/04/2022
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