Provider Demographics
NPI:1538127543
Name:LATZKA, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:LATZKA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 POWELL MILL RD
Mailing Address - Street 2:WESTGATE FAMILY PHYSICIANS
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1531
Mailing Address - Country:US
Mailing Address - Phone:864-574-0070
Mailing Address - Fax:864-574-0882
Practice Address - Street 1:105 POWELL MILL RD
Practice Address - Street 2:WESTGATE FAMILY PHYSICIANS
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1531
Practice Address - Country:US
Practice Address - Phone:864-574-0070
Practice Address - Fax:864-574-0882
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC31123207Q00000X
GA040718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine