MEDICARE: DR. SCOTT A ADDISON 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	207Q00000X	Family Medicine Physician	4301068487	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548236888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT A ADDISON MD

Provider Business Mailing Address
First Line	:	PO BOX 1848
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49443-1848
Country	:	US
Telephone Number	:	231-672-3155
Fax Number	:	231-672-3157

Provider Business Practice Location Address
First Line	:	3570 HENRY ST STE 220
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-4576
Country	:	US
Telephone Number	:	231-672-3155
Fax Number	:	231-672-3157

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	01/11/2022

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