Provider Demographics
NPI:1104137801
Name:LAGOUROS, MEREDITH VIOLET (DO)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:VIOLET
Last Name:LAGOUROS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:VIOLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9010 N ALLEN RD
Mailing Address - Street 2:NONE
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1573
Mailing Address - Country:US
Mailing Address - Phone:309-495-8500
Mailing Address - Fax:
Practice Address - Street 1:9010 N ALLEN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1573
Practice Address - Country:US
Practice Address - Phone:309-495-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.136776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine