Provider Demographics
NPI:1194067496
Name:LAGO, KATHRYN JO (DO)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JO
Last Name:LAGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2938
Mailing Address - Country:US
Mailing Address - Phone:941-366-9060
Mailing Address - Fax:941-953-7076
Practice Address - Street 1:1425 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2938
Practice Address - Country:US
Practice Address - Phone:941-366-9060
Practice Address - Fax:941-953-7076
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004556A208D00000X, 207RI0200X
390200000X
FLOS20931207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program