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General NPI Number Information
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NPI Number | 1134605405
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Entity Type | Individual
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Provider Name | DAVID A LOTZ HIS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 2620 STEWART AVE STE 114
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City | WAUSAU
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State | WI
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Zip | 54401-4170
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Country | US
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Telephone | 715-261-2005
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Fax | 715-261-0481
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Provider Business Mailing Address
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Address Line | 2026 COUNTY HIGHWAY HH
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City | PLOVER
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State | WI
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Zip | 54467
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Country | US
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Telephone | 715-345-0237
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Fax | 715-345-0273
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1537-60
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License Number State | WI
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