Provider Demographics
NPI:1699752394
Name:LOTT, DAVID C (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:LOTT
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 1:4300 COMMERCE CT
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3709
Mailing Address - Country:US
Mailing Address - Phone:630-730-5506
Mailing Address - Fax:
Practice Address - Street 1:4300 COMMERCE CT
Practice Address - Street 2:SUITE 250
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3709
Practice Address - Country:US
Practice Address - Phone:630-730-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361074312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2220936OtherBCBS
IL2220936OtherBCBS
ILK20389Medicare PIN