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General NPI Number Information
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NPI Number | 1790763571
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Entity Type | Individual
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Provider Name | MICHAEL D SCOTT MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 5404 FAIRVIEW AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5332
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Country | US
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Telephone | 630-921-1606
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Fax |
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Provider Business Mailing Address
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Address Line | 5404 FAIRVIEW AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5332
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Country | US
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Telephone | 630-921-1606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036100296
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License Number State | IL
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