Provider Demographics
NPI:1407802531
Name:LAGERKVIST, DAWN D (MD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:D
Last Name:LAGERKVIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3415
Mailing Address - Country:US
Mailing Address - Phone:765-613-0111
Mailing Address - Fax:765-573-5660
Practice Address - Street 1:1320 W SPENCER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3415
Practice Address - Country:US
Practice Address - Phone:765-613-0111
Practice Address - Fax:765-573-5660
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059613A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035320AMedicaid
INI18486Medicare UPIN
IN201035320AMedicaid