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General NPI Number Information
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NPI Number | 1831489996
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Entity Type | Individual
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Provider Name | SCOTT M BOLTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 3232 LAKE AVE STE 330
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City | WILMETTE
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State | IL
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Zip | 60091-1085
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Country | US
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Telephone | 847-570-1795
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Fax | 847-503-4590
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036137475
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.123879
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 35.123879
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 036173195
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License Number State | IL
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