Individual
KENNETH W LAGEROOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
93 CAMPUS AVE, LEWISTON, ME 04240
(207) 777-8442
(207) 777-8425
Mailing address
PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8950
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
DO1227
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037460
ANTHEM BC/BS
ME
01
—
050064569
RAILROAD MEDICARE
—
05
—
325630099
—
ME
Enumeration date
08/28/2006
Last updated
08/15/2019
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