Provider Demographics
NPI:1770849333
Name:LAGE, TATE ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:TATE
Middle Name:ALLEN
Last Name:LAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-2303
Mailing Address - Country:US
Mailing Address - Phone:641-357-7442
Mailing Address - Fax:641-357-3070
Practice Address - Street 1:401 S 15TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2303
Practice Address - Country:US
Practice Address - Phone:641-357-7442
Practice Address - Fax:641-357-3070
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics