Provider Demographics
NPI:1710691423
Name:LOTT, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 WILLOW GROVE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8682
Mailing Address - Country:US
Mailing Address - Phone:810-869-5600
Mailing Address - Fax:
Practice Address - Street 1:2900 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-4452
Practice Address - Country:US
Practice Address - Phone:810-789-9141
Practice Address - Fax:810-789-2130
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
MI4704306210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program