Provider Demographics
NPI:1962665869
Name:LAUTER, JONATHAN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LAUTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W BIG BEAVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3545
Mailing Address - Country:US
Mailing Address - Phone:248-205-3535
Mailing Address - Fax:248-649-5920
Practice Address - Street 1:1800 W BIG BEAVER RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3545
Practice Address - Country:US
Practice Address - Phone:248-205-3535
Practice Address - Fax:248-649-5920
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092841208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics