Provider Demographics
NPI:1154429074
Name:SLOTAR, DYLAN (MD)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:SLOTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 DON S POWERS DR STE 101D
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4070
Mailing Address - Country:US
Mailing Address - Phone:219-301-7244
Mailing Address - Fax:219-595-0889
Practice Address - Street 1:761 45TH AVE
Practice Address - Street 2:STE 103
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2893
Practice Address - Country:US
Practice Address - Phone:219-922-3002
Practice Address - Fax:219-922-3003
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062924A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM47140081OtherMEDICARE PTAN
IN200850540Medicaid
INM47140081OtherMEDICARE PTAN
IN200850540Medicaid