Provider Demographics
NPI:1780872994
Name:LOTT, FEYISETAN (DO)
Entity type:Individual
Prefix:
First Name:FEYISETAN
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-2138
Mailing Address - Country:US
Mailing Address - Phone:405-474-4906
Mailing Address - Fax:
Practice Address - Street 1:801 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4109
Practice Address - Country:US
Practice Address - Phone:620-251-7500
Practice Address - Fax:620-252-1715
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200687530AMedicaid
FL0518514OtherDEA
KS003973002Medicare PIN