Healthcare Provider Details

I. General information

NPI: 1912949181
Provider Name (Legal Business Name): ELISA SCOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 JORIE BLVD SUITE 186
OAK BROOK IL
60523-2213
US

IV. Provider business mailing address

900 JORIE BLVD SUITE 186
OAK BROOK IL
60523-2213
US

V. Phone/Fax

Practice location:
  • Phone: 630-954-6700
  • Fax: 630-954-1555
Mailing address:
  • Phone: 630-954-6700
  • Fax: 630-954-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number036-100748
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: