Healthcare Provider Details

I. General information

NPI: 1225022312
Provider Name (Legal Business Name): JAMES SCOTT DONALDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 9
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE #9 ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-3502
  • Fax: 312-227-9784
Mailing address:
  • Phone: 312-227-3502
  • Fax: 312-227-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number036-070919
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036-070919
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-070919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: