MEDICARE: DR. THOMAS LAGRELIUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G22952	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G022952	OTHER	CA	MEDICAL BOARD OF CA

General Provider Information

NPI Number	:	1386690915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LAGRELIUS

Provider Business Mailing Address
First Line	:	23451 MADISON ST
Second Line	:	140
City	:	TORRANCE
State	:	CA
Zip	:	90505-4763
Country	:	US
Telephone Number	:	310-378-6208
Fax Number	:	310-378-2564

Provider Business Practice Location Address
First Line	:	23451 MADISON ST
Second Line	:	140
City	:	TORRANCE
State	:	CA
Zip	:	90505-4763
Country	:	US
Telephone Number	:	310-378-6208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/10/2007

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