Provider Demographics
NPI:1639731037
Name:LAGUTCHIK, DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LAGUTCHIK
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:66352 HAMPTON PL APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-1317
Mailing Address - Country:US
Mailing Address - Phone:210-859-0868
Mailing Address - Fax:
Practice Address - Street 1:549TH HOSPITAL CENTER/BDAACH
Practice Address - Street 2:UNIT #15245
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:315-737-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2024-01-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant