Individual
DR. JOSHUA R LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3400 UNION AVE, SHEBOYGAN, WI 53081-8426
(920) 802-2100
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
57693-20
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
57693
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100031907
—
WI
Enumeration date
07/22/2011
Last updated
07/15/2024
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