Provider Demographics
NPI:1275538837
Name:LAUKAITIS, MARGARET M (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:LAUKAITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 115
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-398-7701
Practice Address - Fax:727-447-4827
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116978207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012902800Medicaid
FLHY275ZMedicare PIN
PA151013OtherBLUE SHIELD
PA3729952OtherAETNA
PA159439OtherUNISON
PA151013E7CMedicare PIN
PAP00170510OtherRR MEDICARE
PA0008255690008Medicaid
NY02605407OtherNY MEDICAL ASSISTANCE
PA208330OtherUPMC
B39959Medicare UPIN