Provider Demographics
NPI:1386600468
Name:LAGORE, SHANE MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:MICHAEL
Last Name:LAGORE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 LAKESHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1561
Mailing Address - Country:US
Mailing Address - Phone:517-266-0500
Mailing Address - Fax:517-263-0024
Practice Address - Street 1:781 LAKESHIRE TRL
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1561
Practice Address - Country:US
Practice Address - Phone:517-263-2187
Practice Address - Fax:517-263-0024
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ69680Medicare UPIN
MIM35150070Medicare PIN