Individual
DR. CHARLES W LAGOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 624-8818
(309) 624-8820
Mailing address
9401 HOLY CROSS LN, BREESE, IL 62230-3510
(618) 526-7271
(618) 526-8248
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036060508
IL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
036060508
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060508
—
IL
Enumeration date
05/30/2006
Last updated
10/17/2016
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