Individual
KEVIN LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4292
GA
363AS0400X
Surgical Physician Assistant
PA-1765
ID
363AS0400X
Surgical Physician Assistant
PA0000001669
TN
363AS0400X
Surgical Physician Assistant
PA1198
SC
363AS0400X
Surgical Physician Assistant
PA9106353
FL
Other
Enumeration date
03/02/2006
Last updated
03/10/2025
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