Healthcare Provider Details

I. General information

NPI: 1609919364
Provider Name (Legal Business Name): LOTFI BEN-YOUSSEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW STE 108
SIDNEY MT
59270-3521
US

IV. Provider business mailing address

214 14TH AVE SW STE 108
SIDNEY MT
59270-3521
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2277
  • Fax: 406-488-2530
Mailing address:
  • Phone: 406-488-2277
  • Fax: 406-488-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4815
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5302
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: