Healthcare Provider Details

I. General information

NPI: 1851580195
Provider Name (Legal Business Name): DENNIS P MLOT MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 BROADWAY ST
MOUNT VERNON IL
62864-2917
US

IV. Provider business mailing address

2413 BROADWAY ST
MOUNT VERNON IL
62864-2917
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-6559
  • Fax: 618-244-6735
Mailing address:
  • Phone: 618-244-6559
  • Fax: 618-244-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA D MLOT
Title or Position: MANAGER
Credential:
Phone: 618-244-6559