Provider Demographics
NPI:1578580254
Name:A C LOTMAN MD PC
Entity Type:Organization
Organization Name:A C LOTMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-428-9203
Mailing Address - Street 1:8380 ZUNI ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4778
Mailing Address - Country:US
Mailing Address - Phone:303-428-9203
Mailing Address - Fax:
Practice Address - Street 1:8380 ZUNI ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-4778
Practice Address - Country:US
Practice Address - Phone:303-428-9203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04021945Medicaid
COALU0408OtherBLUE SHIELD
CO04021945Medicaid