Provider Demographics
NPI:1609955715
Name:MLOT, DENNIS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PAUL
Last Name:MLOT
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 1:2413 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2917
Mailing Address - Country:US
Mailing Address - Phone:618-244-6559
Mailing Address - Fax:
Practice Address - Street 1:2413 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2917
Practice Address - Country:US
Practice Address - Phone:618-244-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105686207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105686Medicaid
IL04132003OtherBCBS
IL04132003OtherBCBS
ILA16416Medicare UPIN