Individual
CHARLES J LATENDRESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 G AVE, GRUNDY CENTER, IA 50638-1038
(319) 824-3181
(319) 824-6680
Mailing address
1506 G AVE, PO BOX 128, GRUNDY CENTER, IA 50638-1038
(319) 824-3181
(319) 824-6680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21831
IA
Other
Enumeration date
09/30/2005
Last updated
10/14/2016
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