Basic Information
| Provider Information | |||||||||
| NPI: | 1740231547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONALD LAKATOSH, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 890040 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282890040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706158 | ||||||||
| Practice Location | |||||||||
| Address1: | 11560 CHAPMAN HWY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SEYMOUR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378655044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655771914 | ||||||||
| FaxNumber: | 8655771714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | LAKATOSH | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8655771914 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 3725984 | 05 | TN | MEDICAID |