Provider Demographics
NPI:1528023488
Name:LAGONE, AMERICO R (DPM)
Entity type:Individual
Prefix:
First Name:AMERICO
Middle Name:R
Last Name:LAGONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:LAGONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2220 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5442
Mailing Address - Country:US
Mailing Address - Phone:563-263-0000
Mailing Address - Fax:563-263-5113
Practice Address - Street 1:2220 PARK AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761
Practice Address - Country:US
Practice Address - Phone:563-263-0000
Practice Address - Fax:563-263-5113
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00484213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0070946Medicaid
IA0070946Medicaid
IA03221Medicare ID - Type Unspecified
IA480025020Medicare PIN
IA480023818Medicare PIN