Healthcare Provider Details

I. General information

NPI: 1285082248
Provider Name (Legal Business Name): BRYAN SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 COLUMBIA AVE
MUNSTER IN
46321-4008
US

IV. Provider business mailing address

9900 COLUMBIA AVE
MUNSTER IN
46321-4008
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-3300
  • Fax: 219-922-5424
Mailing address:
  • Phone: 219-924-3300
  • Fax: 219-922-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036.165959
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number291082
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: