Individual
MARTIN S LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 JACKSON ST, MC 11503B, SAINT PAUL, MN 55101-2502
(651) 254-3792
(651) 254-8208
Mailing address
8100 34TH AVE S, MAIL STOP 21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-5463
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
44353
MN
2086S0122X
Plastic and Reconstructive Surgery Physician
45762
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322800200
—
MN
Enumeration date
02/27/2006
Last updated
10/23/2012
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