Provider Demographics
NPI:1497700983
Name:LATONA, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LATONA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:STE 281
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3052
Mailing Address - Country:US
Mailing Address - Phone:317-357-8663
Mailing Address - Fax:317-357-5383
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:STE 281
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-357-8663
Practice Address - Fax:317-357-5383
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01044242A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200058110Medicaid
INM400038070OtherMEDICARE ID
IN217840BMedicare PIN
IN200058110Medicaid