Provider Demographics
NPI:1548609944
Name:LAKATOS, JASON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:LAKATOS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1200 BRICKELL BAY DR APT 3224
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3269
Mailing Address - Country:US
Mailing Address - Phone:305-930-1992
Mailing Address - Fax:239-424-3123
Practice Address - Street 1:636 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2668
Practice Address - Country:US
Practice Address - Phone:239-424-3123
Practice Address - Fax:239-424-4041
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2022-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS12984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018322000Medicaid