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General NPI Number Information
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NPI Number | 1073884375
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Entity Type | Individual
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Provider Name | MICHELLE ELIZABETH WILSON LATTING M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 900 NW 17TH ST
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City | MIAMI
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State | FL
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Zip | 33136-1119
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Country | US
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Telephone | 305-326-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 NW 10TH AVE BLDG SUITE114
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City | MIAMI
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State | FL
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Zip | 33136-1015
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Country | US
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Telephone | 305-482-4775
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Fax | 305-326-6306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 2016-01339
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 136723
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License Number State | FL
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