Individual
MICHAEL WILLIAM LAGRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2605 E CREEKS EDGE DR, BLOOMINGTON, IN 47401-8368
(812) 355-2300
(812) 355-2302
Mailing address
2605 E CREEKS EDGE DR, BLOOMINGTON, IN 47401-8368
(812) 355-2300
(812) 355-2302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01066805A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01066805A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200942200
—
IN
Enumeration date
03/24/2008
Last updated
12/17/2020
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