Provider Demographics
NPI:1487972196
Name:J MICHAEL LATHAM M D PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:J MICHAEL LATHAM M D PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-540-3700
Mailing Address - Street 1:1111 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1016
Mailing Address - Country:US
Mailing Address - Phone:407-540-3700
Mailing Address - Fax:407-540-3720
Practice Address - Street 1:1111 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1016
Practice Address - Country:US
Practice Address - Phone:407-540-3700
Practice Address - Fax:407-540-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE664AMedicare PIN