Provider Demographics
NPI:1699775114
Name:LACIKA, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:LACIKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7366
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-7366
Mailing Address - Country:US
Mailing Address - Phone:320-257-5595
Mailing Address - Fax:320-257-5596
Practice Address - Street 1:1990 CONNECTICUT AVE S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2554
Practice Address - Country:US
Practice Address - Phone:320-257-5595
Practice Address - Fax:320-257-5596
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2011-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN235772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411772562OtherGREATWEST HEALTHCARE
MN923872700Medicaid
MN16-29699OtherMEDICA
MN965251008759OtherPREFERRED ONE
MNHP25471OtherHEALTH PARTNERS
MN111023C561OtherUCARE OF MINNESOTA
MN26648OtherARAZ/ AMERICA'S PPO
MN300039114OtherRAILROAD MEDICARE
MN54887LAOtherBLUE CROSS BLUE SHIELD
MN16-29699OtherMEDICA
MN54887LAOtherBLUE CROSS BLUE SHIELD