MEDICARE: DR. LAWRENCE LOTTENBERG MD

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	2086S0102X	Surgical Critical Care Physician	ME27008	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346286184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE LOTTENBERG MD

Provider Business Mailing Address
First Line	:	1234 E DUPONT RD
Second Line	:	SUITE 1
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-373-7854
Fax Number	:	260-458-5664

Provider Business Practice Location Address
First Line	:	11141 PARKVIEW PLAZA DR
Second Line	:	SUITE 305
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1713
Country	:	US
Telephone Number	:	800-633-5331
Fax Number	:	260-266-2009

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/21/2015

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Directions to “ DR. LAWRENCE LOTTENBERG MD” Practice Location

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