Healthcare Provider Details

I. General information

NPI: 1972746568
Provider Name (Legal Business Name): SCOTT THOMAS MCEWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2009
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 S 7TH ST
MINNEAPOLIS MN
55454-1404
US

IV. Provider business mailing address

11100 EUCLID AVE MAILSTOP RB&C 6030
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-365-8001
Mailing address:
  • Phone: 216-844-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35.126953
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number64595
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: