Provider Demographics
NPI:1245227883
Name:LAGOUROS, PARASHOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:PARASHOS
Middle Name:A
Last Name:LAGOUROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8921 N. WOOD SAGE RD.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-2433
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:8921 N. WOOD SAGE RD.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-2433
Practice Address - Fax:309-243-7918
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16050Medicare UPIN
0425500001Medicare NSC
K13468Medicare ID - Type Unspecified