Basic Information
| Provider Information | |||||||||
| NPI: | 1063862779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACKORE | ||||||||
| FirstName: | EVIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7045 S HARRISON HILLS DR APT 208 | ||||||||
| Address2: | |||||||||
| City: | LA VISTA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681287709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026313689 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNMC PEDIATRICS RESIDENCY PROGRAM | ||||||||
| Address2: | 982185 NEBRASKA MEDICAL CENTER | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025595380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2016 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 7646 | NE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.