Provider Demographics
NPI:1356381271
Name:LOPATIN, ERIC DEAN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DEAN
Last Name:LOPATIN
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 1:301 EDWARDSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294
Mailing Address - Country:US
Mailing Address - Phone:618-667-7057
Mailing Address - Fax:618-667-8131
Practice Address - Street 1:301 EDWARDSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294
Practice Address - Country:US
Practice Address - Phone:618-667-7057
Practice Address - Fax:618-667-8131
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075388Medicaid
212777Medicare ID - Type Unspecified
IL036075388Medicaid