Provider Demographics
NPI:1952362477
Name:HADAD, LOTFI (MD)
Entity Type:Individual
Prefix:
First Name:LOTFI
Middle Name:
Last Name:HADAD
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 1:6140 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9133
Mailing Address - Country:US
Mailing Address - Phone:812-475-1948
Mailing Address - Fax:812-401-5777
Practice Address - Street 1:6140 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9133
Practice Address - Country:US
Practice Address - Phone:812-475-1948
Practice Address - Fax:812-401-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059087207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64080435Medicaid
IN200478590Medicaid
H96431Medicare UPIN
KY64080435Medicaid