Healthcare Provider Details

I. General information

NPI: 1487114161
Provider Name (Legal Business Name): ROBYN GRAYSON LOTTES MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 04/30/2024
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST CHICAGO AVENUE
CHICAGO IL
60611
US

IV. Provider business mailing address

225 EAST CHICAGO AVENUE
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 312-227-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: