Individual
DR. MICHAEL D LACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4334 E HIGHLAND DR, JONESBORO, AR 72401-6621
(870) 802-0012
(870) 972-5140
Mailing address
4334 E HIGHLAND DR, JONESBORO, AR 72401-6621
(870) 802-0012
(870) 972-5140
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
C5420
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03100011900
QUALCHOICE
AR
Enumeration date
04/05/2006
Last updated
07/08/2007
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