Healthcare Provider Details

I. General information

NPI: 1164638631
Provider Name (Legal Business Name): LANCE MCLEAN HOTTMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

PO BOX 4778
BLOOMINGTON IN
47402-4778
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-7225
  • Fax:
Mailing address:
  • Phone: 812-336-1690
  • Fax: 812-349-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number03270
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: