Healthcare Provider Details

I. General information

NPI: 1407940166
Provider Name (Legal Business Name): SCOTT FELDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DAVIS ST SUITE # 450
EVANSTON IL
60201-4431
US

IV. Provider business mailing address

1565 MAPLE AVE SUITE 105
EVANSTON IL
60201-4371
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-2404
  • Fax: 847-328-1295
Mailing address:
  • Phone: 847-246-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036095587
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: