MEDICARE: DAVID S LOTSOFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	112982	MO
2	207RG0100X	Gastroenterology Physician	036108442	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178574	OTHER	MO	BC/BS MISSOURI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205807328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID S LOTSOFF M.D.

Provider Business Mailing Address
First Line	:	PO BOX 959203
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-9203
Country	:	US
Telephone Number	:	618-800-4500
Fax Number	:	618-800-4501

Provider Business Practice Location Address
First Line	:	2122 TROY RD STE 130
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-2540
Country	:	US
Telephone Number	:	618-800-4595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	09/16/2025

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