Provider Demographics
NPI:1134605405
Name:LOTZ, DAVID A (HIS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:LOTZ
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 COUNTY HIGHWAY HH
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467
Mailing Address - Country:US
Mailing Address - Phone:715-345-0237
Mailing Address - Fax:715-345-0273
Practice Address - Street 1:2620 STEWART AVE STE 114
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4170
Practice Address - Country:US
Practice Address - Phone:715-261-2005
Practice Address - Fax:715-261-0481
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1537-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist