Healthcare Provider Details

I. General information

NPI: 1134911522
Provider Name (Legal Business Name): TIMOTHY JOHN PASCUAL LATUNO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 COLLINS RD
LANSING MI
48910-8394
US

IV. Provider business mailing address

315 E EDGEWOOD BLVD
LANSING MI
48911-5809
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-6000
  • Fax:
Mailing address:
  • Phone: 661-244-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5151017593
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: