Healthcare Provider Details

I. General information

NPI: 1063462265
Provider Name (Legal Business Name): SCOTT J CINEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK RD
ELMHURST IL
60126-5626
US

IV. Provider business mailing address

172 SCHILLER ST
ELMHURST IL
60126-2885
US

V. Phone/Fax

Practice location:
  • Phone: 630-941-2609
  • Fax: 630-758-8578
Mailing address:
  • Phone: 630-993-5675
  • Fax: 630-758-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036074843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: