Provider Demographics
NPI:1124029012
Name:LACAGNINA, SALVATORE (DO)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:LACAGNINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9371 CYPRESS LAKE DR STE 14
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4995
Mailing Address - Country:US
Mailing Address - Phone:239-579-3800
Mailing Address - Fax:239-766-8555
Practice Address - Street 1:708 DEL PRADO BLVD S STE 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2676
Practice Address - Country:US
Practice Address - Phone:239-424-2120
Practice Address - Fax:239-424-4017
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372912500Medicaid