Provider Demographics
NPI:1962486985
Name:LOTTES, PAUL W (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:LOTTES
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 1:202 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2414
Mailing Address - Country:US
Mailing Address - Phone:319-362-9459
Mailing Address - Fax:319-364-0240
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2414
Practice Address - Country:US
Practice Address - Phone:319-362-9459
Practice Address - Fax:319-364-0240
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0036756Medicaid
IA3121947Medicaid
IA0036756Medicaid
IA50082Medicare PIN
A03506Medicare UPIN
IA27349Medicare PIN