Provider Demographics
NPI:1093940710
Name:LATZKO, MICHAEL PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:LATZKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 SUN N LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2138
Mailing Address - Country:US
Mailing Address - Phone:863-385-1900
Mailing Address - Fax:863-385-9229
Practice Address - Street 1:4301 SUN N LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2138
Practice Address - Country:US
Practice Address - Phone:863-402-3161
Practice Address - Fax:863-402-8244
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME119377208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program