Healthcare Provider Details

I. General information

NPI: 1144495961
Provider Name (Legal Business Name): KARSTEN B SLATER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 COLLEGE DR
MOUNT CARMEL IL
62863
US

IV. Provider business mailing address

1527 COLLEGE DR
MOUNT CARMEL IL
62863-2615
US

V. Phone/Fax

Practice location:
  • Phone: 618-263-6400
  • Fax: 618-263-6291
Mailing address:
  • Phone: 618-263-6400
  • Fax: 618-263-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036128488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: