Provider Demographics
NPI:1184898009
Name:ABRAHAM N. LOTAN, MD
Entity type:Organization
Organization Name:ABRAHAM N. LOTAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:LOTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-758-8106
Mailing Address - Street 1:2535 BETHANY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3126
Mailing Address - Country:US
Mailing Address - Phone:815-758-8106
Mailing Address - Fax:815-758-8108
Practice Address - Street 1:2535 BETHANY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3126
Practice Address - Country:US
Practice Address - Phone:815-758-8106
Practice Address - Fax:815-758-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062654207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45871Medicare UPIN