Provider Demographics
NPI:1285691824
Name:LACH, JOHN A JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:LACH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE. 200-A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-7444
Practice Address - Fax:502-636-7340
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY18965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1172253OtherCHA / NCMA
KY040448OtherSIHO / NCMA
KY50004497OtherPASSPORT / NCMA
KY000028412EOtherHUMANA / NCMA
IN200482450Medicaid
KY2445859000OtherPASSPORT ADVANTAGE / NCMA
KY2525824OtherCIGNA / NCMA
KYP00145996OtherMCR - RR
KY000000327110OtherANTHEM / NMCA
KY64189657Medicaid
KY000028412EOtherHUMANA / NCMA
KY0361988Medicare PIN