Provider Demographics
NPI:1700032646
Name:LANOUE, DOUGLAS ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:LANOUE
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 1:1120 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1477
Mailing Address - Country:US
Mailing Address - Phone:815-268-4840
Mailing Address - Fax:815-268-4845
Practice Address - Street 1:912 W. SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:ONARGA
Practice Address - State:IL
Practice Address - Zip Code:60955
Practice Address - Country:US
Practice Address - Phone:815-268-4843
Practice Address - Fax:815-268-4845
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370647938OtherMOLINA NUMBER