Healthcare Provider Details

I. General information

NPI: 1356381271
Provider Name (Legal Business Name): ERIC DEAN LOPATIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EDWARDSVILLE ROAD
TROY IL
62294
US

IV. Provider business mailing address

301 EDWARDSVILLE ROAD
TROY IL
62294
US

V. Phone/Fax

Practice location:
  • Phone: 618-667-7057
  • Fax: 618-667-8131
Mailing address:
  • Phone: 618-667-7057
  • Fax: 618-667-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036075388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: