Basic Information
| Provider Information | |||||||||
| NPI: | 1730181215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAGIOS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11 BENTON CT | ||||||||
| Address2: | |||||||||
| City: | TIBURON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949201102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157890965 | ||||||||
| FaxNumber: | 4154352293 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 STANYAN ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941171079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156681000 | ||||||||
| FaxNumber: | 4157505573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2005 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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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 | 174400000X | A22300 | CA | Y | Other Service Providers | Specialist |
No ID Information.