MEDICARE: DR. SALVATORE G LACOGNATA D.O.

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	3700	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609901057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALVATORE G LACOGNATA D.O.

Provider Business Mailing Address
First Line	:	3941 E BASELINE RD STE 102
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2750
Country	:	US
Telephone Number	:	480-969-3531
Fax Number	:	480-269-9465

Provider Business Practice Location Address
First Line	:	3941 E BASELINE RD STE 102
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2750
Country	:	US
Telephone Number	:	480-969-3531
Fax Number	:	480-269-9465

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	04/20/2017

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