Healthcare Provider Details

I. General information

NPI: 1942282223
Provider Name (Legal Business Name): SCOTT I SONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E PHILLIP RD STE 1105
VERNON HILLS IL
60061-1700
US

IV. Provider business mailing address

6 E PHILLIP RD STE 1105
VERNON HILLS IL
60061-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-0691
  • Fax: 847-362-0694
Mailing address:
  • Phone: 847-362-0691
  • Fax: 847-362-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: