Organization
DPN-FL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICK LAGO MD (PRESIDENT)
(248) 631-9171
Entity
Organization
Contact information
Practice address
13517 DEEP BLUE PL, BRADENTON, FL 34211-4129
(313) 329-2646
Mailing address
13517 DEEP BLUE PL, BRADENTON, FL 34211-4129
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
02/20/2023
Last updated
02/20/2023
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