Provider Demographics
NPI:1184625758
Name:LAITINEN, DAVID W (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:LAITINEN
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 1:225 S PINE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2365
Mailing Address - Country:US
Mailing Address - Phone:812-524-3311
Mailing Address - Fax:812-524-3312
Practice Address - Street 1:225 S PINE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2365
Practice Address - Country:US
Practice Address - Phone:812-524-3311
Practice Address - Fax:812-524-3312
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032417207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093074OtherANTHEM BCBS
IN0246440001OtherDME
IN100140540AMedicaid
IN0246440001OtherDME
IN100140540AMedicaid