Provider Demographics
NPI:1235254608
Name:LATEEF, HUMAIRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMAIRA
Middle Name:K
Last Name:LATEEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HUMAIRA
Other - Middle Name:
Other - Last Name:NADEEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-885-5688
Mailing Address - Fax:
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:STE 140
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-455-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090954207Q00000X
OH35.090954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2844739Medicaid
00000057142OtherANTHEM
9532178OtherAETNA
9532178OtherAETNA
H039080Medicare PIN