Healthcare Provider Details

I. General information

NPI: 1528029949
Provider Name (Legal Business Name): GEOFFREY A SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 W OAKWOOD PARK CT
FRANKLIN WI
53132-9118
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-423-5250
  • Fax: 414-423-5256
Mailing address:
  • Phone: 414-423-5250
  • Fax: 414-423-5256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32373
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: