Provider Demographics
NPI:1689735946
Name:LAHTI, MARIA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:RENEE
Last Name:LAHTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:R
Other - Last Name:KOSTUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4586 E HIGHWAY 20 STE C
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9802
Mailing Address - Country:US
Mailing Address - Phone:850-278-3874
Mailing Address - Fax:
Practice Address - Street 1:4586 E HIGHWAY 20 STE C
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9802
Practice Address - Country:US
Practice Address - Phone:850-278-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19717207RC0000X
LA026217207RC0000X
FLME128217207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease