Provider Demographics
NPI:1063420529
Name:LOTFI, AHAD E (DC)
Entity type:Individual
Prefix:DR
First Name:AHAD
Middle Name:E
Last Name:LOTFI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60069 COUNTY ROAD 687
Mailing Address - Street 2:P.O.BOX 621
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9601
Mailing Address - Country:US
Mailing Address - Phone:269-621-3800
Mailing Address - Fax:269-621-2556
Practice Address - Street 1:60069 CR 687
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-0621
Practice Address - Country:US
Practice Address - Phone:269-621-3800
Practice Address - Fax:269-621-2556
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3427986Medicaid
950H050160OtherBCBS
U67929Medicare UPIN
MI3427986Medicaid