Individual
LANE M LAGATTUTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-2282
(708) 202-2281
Mailing address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-9100
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
036159941
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
125.072770
IL
Other
Enumeration date
06/05/2018
Last updated
02/29/2024
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