Basic Information
| Provider Information | |||||||||
| NPI: | 1548609944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAKATOS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 BRICKELL BAY DR APT 3224 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331313269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059301992 | ||||||||
| FaxNumber: | 2394243123 | ||||||||
| Practice Location | |||||||||
| Address1: | 636 DEL PRADO BLVD S | ||||||||
| Address2: | |||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339902668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394243123 | ||||||||
| FaxNumber: | 2394244041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2013 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS12984 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 018322000 | 05 | FL | MEDICAID |