Provider Demographics
NPI:1194062661
Name:DR. KAYE LAGDAAN, P.C.
Entity type:Organization
Organization Name:DR. KAYE LAGDAAN, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGDAAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-532-8321
Mailing Address - Street 1:4112 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3028
Mailing Address - Country:US
Mailing Address - Phone:773-697-3511
Mailing Address - Fax:773-697-3512
Practice Address - Street 1:4112 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3028
Practice Address - Country:US
Practice Address - Phone:773-697-3511
Practice Address - Fax:773-697-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005452213E00000X
213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty