Provider Demographics
NPI:1609919364
Name:BEN-YOUSSEF, LOTFI (MD)
Entity Type:Individual
Prefix:DR
First Name:LOTFI
Middle Name:
Last Name:BEN-YOUSSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 14TH AVE SW STE 108
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2277
Mailing Address - Fax:406-488-2530
Practice Address - Street 1:214 14TH AVE SW STE 108
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2277
Practice Address - Fax:406-488-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4815207X00000X
ND5302207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0069628Medicaid
ND15041Medicaid
MT000017170OtherBC BS MT
MT0179554Medicaid
MT0000082342OtherMEDICARE GROUP
184683900OtherFEDERAL WC
200001236OtherRR MEDICARE
MT000017170OtherBC BS MT
MT0251820001Medicare NSC
MT011000600Medicare PIN
ND15041Medicaid