Individual
MALINDA J LASATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2824 ELKHART RD STE A, GOSHEN, IN 46526-1014
(574) 535-1700
(574) 535-1799
Mailing address
2824 ELKHART RD STE A, GOSHEN, IN 46526-1014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004317A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201105370
—
IN
Enumeration date
06/07/2012
Last updated
03/18/2024
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