Provider Demographics
NPI:1952662777
Name:LASATER, MALINDA J (DO)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:J
Last Name:LASATER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2824 ELKHART RD STE A
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2824 ELKHART RD STE A
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1014
Practice Address - Country:US
Practice Address - Phone:574-535-1700
Practice Address - Fax:574-535-1799
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2024-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02004317A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201105370Medicaid