Provider Demographics
NPI:1063644052
Name:LAGDAAN, KAYE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAYE
Middle Name:
Last Name:LAGDAAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:KAYE
Other - Middle Name:LAGDAAN
Other - Last Name:PUETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4112 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3028
Mailing Address - Country:US
Mailing Address - Phone:773-697-3511
Mailing Address - Fax:773-697-3512
Practice Address - Street 1:4112 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3028
Practice Address - Country:US
Practice Address - Phone:773-697-3511
Practice Address - Fax:773-697-3512
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery