Individual
DR. CYNTHIA K LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
425 FISHER ST, MARQUETTE, MI 49855-4521
(906) 226-4618
(906) 226-5317
Mailing address
124 E MAGNETIC ST, MARQUETTE, MI 49855-3045
(906) 228-5146
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301042623
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3088765
—
MI
Enumeration date
09/13/2006
Last updated
07/09/2007
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