Healthcare Provider Details

I. General information

NPI: 1942890959
Provider Name (Legal Business Name): MATTHEW JAMES LOTTES B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 PIONEER TRL
CEDAR SPRINGS MI
49319-8136
US

IV. Provider business mailing address

1447 HAZEN ST SE
GRAND RAPIDS MI
49507-3712
US

V. Phone/Fax

Practice location:
  • Phone: 616-251-8162
  • Fax: 616-327-4660
Mailing address:
  • Phone: 517-290-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: