Healthcare Provider Details

I. General information

NPI: 1295713766
Provider Name (Legal Business Name): LLOYD M FLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 SYCAMORE ST
MARSEILLES IL
61341-1366
US

IV. Provider business mailing address

25259 S REED ST
CHANNAHON IL
60410-6003
US

V. Phone/Fax

Practice location:
  • Phone: 815-795-2122
  • Fax: 815-795-3507
Mailing address:
  • Phone: 815-941-9124
  • Fax: 815-941-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036089865
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: