# CHARLES J LATENDRESSE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407030513
- **Authorized official:** DR. CHARLES J LATENDRESSE MD (OWNER)
- **Authorized official phone:** (319) 824-3181

## Contact information

- **Practice address:** 1506 G AVE, GRUNDY CENTER, IA 50638-1038
- **Practice address phone:** (319) 824-3181
- **Practice address fax:** (319) 824-6680
- **Mailing address:** PO BOX 128, GRUNDY CENTER, IA 50638-0128
- **Mailing address phone:** (319) 824-3181
- **Mailing address fax:** (319) 824-6680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2007
- **Last updated:** 12/26/2007