Provider Demographics
NPI:1902462880
Name:DYLAN SLOTAR MD PC
Entity Type:Organization
Organization Name:DYLAN SLOTAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-301-7265
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0697
Mailing Address - Country:US
Mailing Address - Phone:219-301-7265
Mailing Address - Fax:
Practice Address - Street 1:9124 COLUMBIA AVE # B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2907
Practice Address - Country:US
Practice Address - Phone:844-450-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01062924AOtherIN MD LICENSE NUMBER