MEDICARE: DR. MICHAEL LOTZ PHD, HSPP

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	103TC1900X	Counseling Psychologist	20043736B	IN

General Provider Information

NPI Number	:	1912766718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LOTZ PHD, HSPP

Provider Business Mailing Address
First Line	:	3250A W 86TH ST # 1001
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250A W 86TH ST # 1001
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3605
Country	:	US
Telephone Number	:	812-805-0416
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/15/2024

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