Basic Information
Provider Information
NPI: 1003149295
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAKATOS
FirstName: ANNE
MiddleName: E B
NamePrefix: MRS.
NameSuffix:  
Credential: APN-BC, APNP, RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BLAHA
OtherFirstName: ANNE
OtherMiddleName: E
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 9200 W WISCONSIN AVE
Address2: DEPT OF INTERNAL MEDICINE
City: MILWAUKEE
State: WI
PostalCode: 532263522
CountryCode: US
TelephoneNumber: 4148056850
FaxNumber: 4148056851
Practice Location
Address1: 9200 W WISCONSIN AVE
Address2: DEPT OF INTERNAL MEDICINE
City: MILWAUKEE
State: WI
PostalCode: 532263522
CountryCode: US
TelephoneNumber: 4148056850
FaxNumber: 4148056851
Other Information
ProviderEnumerationDate: 09/07/2009
LastUpdateDate: 12/04/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X3833WIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LP2300X3833-33WIN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care

ID Information
IDTypeStateIssuerDescription
100314929505WI MEDICAID


Home