Healthcare Provider Details

I. General information

NPI: 1386638708
Provider Name (Legal Business Name): SCOTT MACKAY MORCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E SCRANTON AVE STE 303
LAKE BLUFF IL
60044-2561
US

IV. Provider business mailing address

10 E SCRANTON AVE STE 303
LAKE BLUFF IL
60044-2561
US

V. Phone/Fax

Practice location:
  • Phone: 847-816-3434
  • Fax: 847-686-7284
Mailing address:
  • Phone: 847-757-8686
  • Fax: 847-686-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-099609
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: