Healthcare Provider Details

I. General information

NPI: 1558563213
Provider Name (Legal Business Name): SCOTT GLEN ASSELMEIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W HIGHWAY 22 DEPT OF RADIOLOGY
BARRINGTON IL
60010-1919
US

IV. Provider business mailing address

466 PENNSYLVANIA AVE APT A
GLEN ELLYN IL
60137-4458
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4270
  • Fax: 312-563-4280
Mailing address:
  • Phone: 313-570-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036-115765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: