Healthcare Provider Details

I. General information

NPI: 1467440297
Provider Name (Legal Business Name): THOMAS MALCOLM SCOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30730 FORD RD
GARDEN CITY MI
48135-1803
US

IV. Provider business mailing address

30730 FORD RD
GARDEN CITY MI
48135-1803
US

V. Phone/Fax

Practice location:
  • Phone: 734-421-7474
  • Fax: 734-421-0961
Mailing address:
  • Phone: 734-421-7474
  • Fax: 734-421-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101010296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: