Provider Demographics
NPI:1033151642
Name:MAGAT, LAKAN KARLO G (MD)
Entity type:Individual
Prefix:
First Name:LAKAN KARLO
Middle Name:G
Last Name:MAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1430
Mailing Address - Country:US
Mailing Address - Phone:302-261-5600
Mailing Address - Fax:302-617-7541
Practice Address - Street 1:600 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1430
Practice Address - Country:US
Practice Address - Phone:302-261-5600
Practice Address - Fax:302-617-7541
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035284Medicaid
DEI20822Medicare UPIN
DEG02351F01Medicare ID - Type Unspecified