Provider Demographics
NPI:1467439232
Name:LAGO, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:LAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-1114
Mailing Address - Country:US
Mailing Address - Phone:330-875-5544
Mailing Address - Fax:330-875-8150
Practice Address - Street 1:1302 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1114
Practice Address - Country:US
Practice Address - Phone:330-875-5544
Practice Address - Fax:330-875-8150
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959968Medicaid
OH0959968Medicaid