=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659585073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JOSEPH LATTEIER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 07/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10701 NALL AVE SUITE 200
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66211-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-5225
-----------------------------------------------------
Fax | 913-901-0186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12639 OLD TESSON RD SUITE 100
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63128-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-381-5225
-----------------------------------------------------
Fax | 913-901-0186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 44813
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 4301080457
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------