Individual
ELIJAH AUSTIN LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 E HARMONY RD, FORT COLLINS, CO 80528-3400
(970) 226-6111
(970) 226-6707
Mailing address
2121 E HARMONY RD UNIT 180, FORT COLLINS, CO 80528-3401
(970) 226-6111
(970) 226-6707
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2022-00049
CO
2084N0400X
Neurology Physician
Primary
2022-00049
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2018
Last updated
08/03/2026
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