Healthcare Provider Details

I. General information

NPI: 1447216965
Provider Name (Legal Business Name): SCOTT HARLAN EHMEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PROVIDENT DR STE A
WARSAW IN
46580-3297
US

IV. Provider business mailing address

P.O. BOX 110
WARSAW IN
46580
US

V. Phone/Fax

Practice location:
  • Phone: 574-372-7637
  • Fax: 574-372-7689
Mailing address:
  • Phone: 574-267-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01054904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: