Healthcare Provider Details

I. General information

NPI: 1740231547
Provider Name (Legal Business Name): DONALD LAKATOSH, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 CHAPMAN HWY SUITE 1
SEYMOUR TN
37865-5044
US

IV. Provider business mailing address

PO BOX 890040
CHARLOTTE NC
28289-0040
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-1914
  • Fax: 865-577-1714
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. DONALD ANDREW LAKATOSH
Title or Position: OWNER
Credential: M.D.
Phone: 865-577-1914