MEDICARE: KISHOR G LATHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	044999	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487641601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHOR G LATHI MD

Provider Business Mailing Address
First Line	:	45 SECOR RD
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-7224
Country	:	US
Telephone Number	:	914-713-4130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 WASHINGTON BLVD
Second Line	:	SUITE 440
City	:	STAMFORD
State	:	CT
Zip	:	06901-2216
Country	:	US
Telephone Number	:	203-348-2614
Fax Number	:	203-325-8677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/30/2007

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