Individual
MICHAEL LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4104 SHILOH VALLEY RD, EDMOND, OK 73034-6912
(405) 482-0313
Mailing address
4104 SHILOH VALLEY RD, EDMOND, OK 73034-6912
(405) 482-0313
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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