Provider Demographics
NPI:1366409104
Name:LACHICA, ROBERTO D (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:D
Last Name:LACHICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WEST DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-1728
Mailing Address - Country:US
Mailing Address - Phone:901-210-1302
Mailing Address - Fax:
Practice Address - Street 1:6029 WALNUT GROVE RD STE 210
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-226-3090
Practice Address - Fax:901-226-3096
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS270952086S0122X
TN305512086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1366409104Medicaid
GA003179561AMedicaid
MS1366409104Medicaid
TN3829310Medicaid
AL177417Medicaid
TNQ019227Medicaid
AR135632001Medicaid