MEDICARE: LOTUS HEALTH, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1699335521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS HEALTH, LLC

Provider Business Mailing Address
First Line	:	1776 S. MAIN STREET
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-1951
Country	:	US
Telephone Number	:	801-872-8846
Fax Number	:	801-449-0982

Provider Business Practice Location Address
First Line	:	2605 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2728
Country	:	US
Telephone Number	:	801-872-8846
Fax Number	:	801-449-0982

Authorized Official
Title or Position	:	MD
Name	:	MELISSA CHAN LEWIS
Credential	:	MD
Telephone Number	:	801-872-8846

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	03/07/2023

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Directions to “LOTUS HEALTH, LLC ” Practice Location

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