Provider Demographics
NPI:1760418214
Name:LOTAN, ABRAHAM N (MD)
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:N
Last Name:LOTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2127 MIDLANDS CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3173
Mailing Address - Country:US
Mailing Address - Phone:815-758-8106
Mailing Address - Fax:815-758-8108
Practice Address - Street 1:2127 MIDLANDS CT
Practice Address - Street 2:SUITE 203
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3173
Practice Address - Country:US
Practice Address - Phone:815-758-8106
Practice Address - Fax:815-758-8108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062654207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062654Medicaid
IL4500644OtherBCBS
IL216367Medicare PIN