Provider Demographics
NPI:1972567873
Name:LATTERELL, LOUISE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:F
Last Name:LATTERELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 E. CAMPUS MALL RM 8104
Mailing Address - Street 2:UNIVERSITY HEALTH SERVICES
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1381
Mailing Address - Country:US
Mailing Address - Phone:608-265-5600
Mailing Address - Fax:608-262-9160
Practice Address - Street 1:333 E CAMPUS MALL RM 8104
Practice Address - Street 2:UNIVERSITY HEALTH SERVICES
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1381
Practice Address - Country:US
Practice Address - Phone:608-265-5600
Practice Address - Fax:608-262-9160
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32512000Medicaid
WI32512000Medicaid
015C15875Medicare ID - Type Unspecified