Provider Demographics
NPI:1548329550
Name:LOTUS UROLOGIC GROUP
Entity type:Organization
Organization Name:LOTUS UROLOGIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-236-5187
Mailing Address - Street 1:105 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2277
Mailing Address - Country:US
Mailing Address - Phone:276-236-5187
Mailing Address - Fax:276-236-3015
Practice Address - Street 1:105 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2277
Practice Address - Country:US
Practice Address - Phone:276-236-5187
Practice Address - Fax:276-236-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADE0083OtherMEDICARE RAILROAD
NC5902112Medicaid
VA010188491Medicaid
VAG93722Medicare UPIN
VA5503130001Medicare NSC
VA010188491Medicaid