Healthcare Provider Details

I. General information

NPI: 1982616645
Provider Name (Legal Business Name): SCOTT R ANTOINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N RANGELINE RD
CARMEL IN
46032-1741
US

IV. Provider business mailing address

40 N RANGELINE RD
CARMEL IN
46032-1741
US

V. Phone/Fax

Practice location:
  • Phone: 317-989-8463
  • Fax: 877-257-4003
Mailing address:
  • Phone: 317-989-8463
  • Fax: 877-257-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02002894
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02002894A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: