Individual
DEAN LOLLER RIDER
Active
Individual
DEAN LOLLER RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G401240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001800143
BLUE SHIELD HIGHMARK OF P
—
01
—
00G401240
CARE ADVANTAGE
—
01
—
013478
HILL PHYSICIANS MED GRP
—
01
—
5422000G401240
BLUE SHIELD OF CAL
—
01
—
600632
BROWN AND TOLAND MED GRP
—
01
—
942983437
BLUE CROSS PERS CARE
—
01
—
9429834370001
CIGNA HEALTHCARE
—
Enumeration date
09/14/2006
Last updated
06/14/2023
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