Healthcare Provider Details

I. General information

NPI: 1053305128
Provider Name (Legal Business Name): WENDY JANE LOTTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY JANE MOFFATT MD

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TOWER CT
GURNEE IL
60031-3336
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-1375
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036085957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: