Individual
PETRONIO ILAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3900 ST FRANCIS WAY STE 200, LAFAYETTE, IN 47905-4940
(765) 775-2800
(765) 775-2831
Mailing address
1040 SIERRA DR STE 400, GREENWOOD, IN 46143-7241
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01030521A
IN
2084N0400X
Neurology Physician
MD425688
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100250920
—
IN
05
—
1011908700001
—
PA
01
—
231420CC
MEDICARE
IN
Enumeration date
05/18/2006
Last updated
06/07/2021
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