Provider Demographics
NPI:1427623057
Name:DPN-MI PC
Entity type:Organization
Organization Name:DPN-MI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:530-350-0889
Mailing Address - Street 1:29877 TELEGRAPH RD STE LL-12
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-213-6222
Mailing Address - Fax:248-226-5827
Practice Address - Street 1:29877 TELEGRAPH RD STE L-12
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7657
Practice Address - Country:US
Practice Address - Phone:657-439-4455
Practice Address - Fax:248-226-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center