Healthcare Provider Details

I. General information

NPI: 1225012990
Provider Name (Legal Business Name): GREGORY MARSHALL SCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W CENTRAL RD SUITE 105
ARLINGTON HEIGHTS IL
60005-2490
US

IV. Provider business mailing address

800 BIESTERFIELD RD SUITE 510
ELK GROVE VILLAGE IL
60007-3361
US

V. Phone/Fax

Practice location:
  • Phone: 847-818-1184
  • Fax: 847-818-0980
Mailing address:
  • Phone: 847-981-3660
  • Fax: 847-956-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036--098106
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: