Healthcare Provider Details

I. General information

NPI: 1093005399
Provider Name (Legal Business Name): SCOTT ALAN GERSHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1000
CHICAGO IL
60611-8709
US

IV. Provider business mailing address

446 E ONTARIO ST STE 7-200
CHICAGO IL
60611-4418
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-2198
  • Fax: 312-695-6594
Mailing address:
  • Phone: 312-926-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036140712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: