Healthcare Provider Details

I. General information

NPI: 1063444966
Provider Name (Legal Business Name): COLLEEN M SCOTT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22905 W MAIN ST
ARMADA MI
48005-3247
US

IV. Provider business mailing address

22905 W MAIN ST P.O.BOX 536
ARMADA MI
48005-3247
US

V. Phone/Fax

Practice location:
  • Phone: 586-473-8082
  • Fax: 586-473-8129
Mailing address:
  • Phone: 585-864-7380
  • Fax: 586-473-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014932
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: