Provider Demographics
NPI:1003153362
Name:LOTFI, MAHMOUD S (DC)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:S
Last Name:LOTFI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2205
Mailing Address - Country:US
Mailing Address - Phone:312-944-4653
Mailing Address - Fax:
Practice Address - Street 1:3139 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2205
Practice Address - Country:US
Practice Address - Phone:312-944-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor