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General NPI Number Information
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NPI Number | 1437572831
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Entity Type | Organization
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Legal Business Name | PATHFINDER MEDICAL GROUP
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 216 MILWAUKEE ST SUITE 2D
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City | MILWAUKEE
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State | WI
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Zip | 53202
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Country | US
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Telephone | 262-240-1031
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Fax |
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Provider Business Mailing Address
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Address Line | 191 E DEERPATH STE 102
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City | LAKE FOREST
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State | IL
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Zip | 60045-1900
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Country | US
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Telephone | 847-686-7284
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Fax |
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Authorized Official
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Title or Position | CHEIF MEDICAL OFFICER
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Name | SCOTT MORCOTT
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Credential | M.D
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Telephone | 847-757-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35906-20
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License Number State | WI
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