Basic Information
| Provider Information | |||||||||
| NPI: | 1316991250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOTT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 564437 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606564437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732486913 | ||||||||
| FaxNumber: | 7732488464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 N SHERIDAN RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606576156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732486913 | ||||||||
| FaxNumber: | 7732488464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036043445 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036043445 | 05 | IL | MEDICAID |