Provider Demographics
NPI:1851396840
Name:LATOUF, BUTROS (MD)
Entity Type:Individual
Prefix:DR
First Name:BUTROS
Middle Name:
Last Name:LATOUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 TOWNSHIP ROAD 336
Mailing Address - Street 2:STE B
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654
Mailing Address - Country:US
Mailing Address - Phone:330-674-3434
Mailing Address - Fax:330-674-3731
Practice Address - Street 1:5354 TOWNSHIP ROAD 336
Practice Address - Street 2:STE B
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654
Practice Address - Country:US
Practice Address - Phone:330-674-3434
Practice Address - Fax:330-674-3731
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064619207R00000X
OH35064619L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0937204Medicaid
OH110177263OtherRAILROAD MEDICARE
OHLA0748872Medicare ID - Type UnspecifiedMLBG LOCATION
OH0937204Medicaid