Provider Demographics
NPI:1700882602
Name:LACEY, MICHAEL GEORGE (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:LACEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E SCHAUMBURG RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3548
Mailing Address - Country:US
Mailing Address - Phone:847-352-1473
Mailing Address - Fax:847-352-1479
Practice Address - Street 1:333 W 89TH AVE STE W5
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7050
Practice Address - Country:US
Practice Address - Phone:219-662-2279
Practice Address - Fax:855-742-9438
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005210213E00000X, 213EP0504X, 213EP1101X, 213ES0131X, 213ES0103X
IN07001055A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007131702OtherAETNA
IN200901510Medicaid
IL00002490663 05OtherUNITED HEALTHCARE
ILK12046Medicare PIN
ILK12045Medicare PIN
IL00002490663 05OtherUNITED HEALTHCARE
IL212062Medicare PIN
IN210580JMedicare PIN
ILV02139Medicare UPIN