MEDICARE: SCOTT LAWRENCE SINNOTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01052442A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10825958	OTHER	IN	CAQH NUMBER
2	000000110862	OTHER	IN	ANTHEM PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000805393	OTHER		ANTHEM
5	9397472	OTHER	IN	PHCS PID NUMBER

General Provider Information

NPI Number	:	1366401184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT LAWRENCE SINNOTT MD

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	3920 ST FRANCIS WAY
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4917
Country	:	US
Telephone Number	:	765-428-5990
Fax Number	:	765-428-5896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	09/14/2023

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Directions to “ SCOTT LAWRENCE SINNOTT MD” Practice Location

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