Provider Demographics
NPI:1730173691
Name:LOTMAN, ANTON ERIKOVICH (MD)
Entity type:Individual
Prefix:DR
First Name:ANTON
Middle Name:ERIKOVICH
Last Name:LOTMAN
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 1:5915 SUMMERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-6073
Mailing Address - Country:US
Mailing Address - Phone:541-297-1665
Mailing Address - Fax:
Practice Address - Street 1:1155 35TH LN STE 100B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6521
Practice Address - Country:US
Practice Address - Phone:772-770-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261342084N0400X
FLME1674002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME167400OtherFLORIDA MEDICAL LICENSE
OR026822Medicaid
OR930635514OtherTAX ID
OR930802343OtherTAX ID#
OR1407812365OtherMEDICARE GROUP NPI
FL121920100Medicaid
ORR0000WFBTVOtherMEDICARE GROUP PIN
OR0577260001Medicare NSC
ORR000WCKDHMedicare PIN