Organization
DR ROY LACEY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROY LACEY D.O. (OWNER)
(773) 778-1950
Entity
Organization
Contact information
Practice address
8058 S WESTERN AVE, CHICAGO, IL 60620-5936
(773) 778-1950
(773) 778-5343
Mailing address
8058 S WESTERN AVE, CHICAGO, IL 60620-5936
(773) 778-1950
(773) 778-5343
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036055042
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036055042
—
IL
01
—
1487638847
NPI
IL
Enumeration date
06/08/2009
Last updated
06/08/2009
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