Provider Demographics
NPI:1679540363
Name:LAGWINSKI, MIKAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKAEL
Middle Name:D
Last Name:LAGWINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:998 E SHADOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-2750
Mailing Address - Country:US
Mailing Address - Phone:903-241-1474
Mailing Address - Fax:903-232-8226
Practice Address - Street 1:3277 E LOUISE DR STE 350
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5510
Practice Address - Country:US
Practice Address - Phone:208-887-9500
Practice Address - Fax:208-887-9800
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM-9599207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM-9599OtherIDAHO BOARD OF MEDICINE
TX8B8277Medicare ID - Type Unspecified