Provider Demographics
NPI:1205807328
Name:LOTSOFF, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:LOTSOFF
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 1:200 BREVCO PLZ
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2949
Mailing Address - Country:US
Mailing Address - Phone:636-561-9020
Mailing Address - Fax:
Practice Address - Street 1:200 BREVCO PLZ
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2949
Practice Address - Country:US
Practice Address - Phone:636-561-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112982207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208433805Medicaid
MO178574OtherBC/BS MISSOURI
MOH83971Medicare UPIN
MO070011461Medicare ID - Type Unspecified
MOMA1838007Medicare PIN