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General NPI Number Information
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NPI Number | 1548433360
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Entity Type | Organization
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Legal Business Name | RONALD P D'AGOSTINO DO PC
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Dates
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Enumeration Date | 04/12/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 108 W EASTERN AVE
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City | LANSE
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State | MI
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Zip | 49946-1214
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Country | US
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Telephone | 906-524-6366
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Fax | 906-524-6014
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Provider Business Mailing Address
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Address Line | 108 W EASTERN AVE
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City | LANSE
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State | MI
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Zip | 49946-1214
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Country | US
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Telephone | 906-524-7121
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Fax | 906-524-6014
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. RONALD P D'AGOSTINO
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Credential | DO
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Telephone | 906-524-7121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101008281
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License Number State | MI
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