Provider Demographics
NPI:1295713766
Name:FLATT, LLOYD M (MD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:M
Last Name:FLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25259 S REED ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-6003
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:580 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1366
Practice Address - Country:US
Practice Address - Phone:815-795-2122
Practice Address - Fax:815-795-3507
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089865-3Medicaid
IL036089865-2Medicaid
ILF92159Medicare UPIN
IL808070Medicare ID - Type Unspecified