Provider Demographics
NPI:1891094306
Name:LAGO, MICHAEL TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:LAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3804 S JACKSON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6681
Mailing Address - Country:US
Mailing Address - Phone:956-296-3001
Mailing Address - Fax:956-296-3000
Practice Address - Street 1:3804 S JACKSON RD STE 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6681
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-296-3001
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR5421207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08LK12801OtherBCBS
TX3788572-03Medicaid