Provider Demographics
NPI:1851580195
Name:DENNIS P MLOT MD LLC
Entity Type:Organization
Organization Name:DENNIS P MLOT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-244-6559
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:618-244-6735
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:618-244-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04132003OtherBCBS ILLINOIS
IL04132003OtherBCBS ILLINOIS