Provider Demographics
NPI:1710925706
Name:LATHROP, DANIEL T (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:LATHROP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2420
Mailing Address - Country:US
Mailing Address - Phone:231-933-9833
Mailing Address - Fax:
Practice Address - Street 1:620 WOODMERE AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3397
Practice Address - Country:US
Practice Address - Phone:231-946-8822
Practice Address - Fax:231-947-0977
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDL000642213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2879040Medicaid
MI2879040Medicaid
MIOB86034001Medicare ID - Type Unspecified