Individual
WILLIAM OWEN LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4606 GREENWOOD RD, LOUISVILLE, KY 40258
(502) 937-2209
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
28706
KY
207RP1001X
Pulmonary Disease Physician
28706
KY
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
28706
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200003570
INDIANA MEDICAID
IN
05
—
64287063
—
KY
Enumeration date
10/05/2006
Last updated
11/20/2024
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