Healthcare Provider Details

I. General information

NPI: 1083864151
Provider Name (Legal Business Name): TARA SCOTT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR SUITE 608
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

22250 PROVIDENCE DR SUITE 608
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-6500
  • Fax: 248-557-2781
Mailing address:
  • Phone: 248-557-6500
  • Fax: 248-557-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberTS001844
License Number StateMI

VIII. Authorized Official

Name: DR. TARA LONG SCOTT
Title or Position: OWNER / CEO
Credential: DPM
Phone: 248-557-6500