Healthcare Provider Details

I. General information

NPI: 1437158326
Provider Name (Legal Business Name): SCOTT A SEYMOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E BURLINGTON ST STE 100
RIVERSIDE IL
60546-2082
US

IV. Provider business mailing address

353 E BURLINGTON ST STE 100
RIVERSIDE IL
60546-2082
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-0221
  • Fax: 708-442-5670
Mailing address:
  • Phone: 708-442-0221
  • Fax: 708-442-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036077172
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: