Provider Demographics
NPI:1043476039
Name:ROBERT SLOTT MD PC
Entity type:Organization
Organization Name:ROBERT SLOTT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:SLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-871-4183
Mailing Address - Street 1:2934 W SUMMERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4006
Mailing Address - Country:US
Mailing Address - Phone:773-871-4183
Mailing Address - Fax:773-883-1202
Practice Address - Street 1:2800 N SHERIDAN RD STE 215
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6160
Practice Address - Country:US
Practice Address - Phone:773-871-4183
Practice Address - Fax:773-883-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21604182OtherBLUE SHIELD
IL036043445Medicaid
IL21604182OtherBLUE SHIELD
IL472880Medicare PIN