Cynthia K Lack, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301042623 Issued in MI

Practice address

425 Fisher St
Marquette, MI 49855-4521

Phone

(906) 226-4618

Fax

(906) 226-5317

NPI assigned

Sep 13, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1104920628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 E MAGNETIC ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498553045",
            "telephone_number": "906-228-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 FISHER ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554521",
            "telephone_number": "906-226-4618",
            "fax_number": "906-226-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACK",
        "first_name": "CYNTHIA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301042623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3088765",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Rae Kuzmak Aho, LMSW
• Ava Kyer
• David Ala Kyle, O.D.
• Mary Elizabeth Labelle, B.S. PHARM, RPH.
• Timothy John Labonte, MD
• Anthony N Lackey, P.A.
• Branimir A. Lackovic, DDS
• Deanna Lacosse, NP
• Lacy Williams, LLC
• Jeremy Joseph Lafave, CRNA

• Family Medicine Physician in Marquette, MI
• Providers in Marquette, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.