Provider Demographics
NPI:1316991250
Name:SLOTT, ROBERT I (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:SLOTT
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:PO BOX 564437
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-4437
Mailing Address - Country:US
Mailing Address - Phone:773-248-6913
Mailing Address - Fax:773-248-8464
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 309
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-248-6913
Practice Address - Fax:773-248-8464
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043445Medicaid
C41859Medicare UPIN