MEDICARE: DR. DAVID BRUCE SCOTT DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	887-025	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000550791	OTHER	IN	ANTHEM BCBS
2	P00144281	OTHER	WI	RAILROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043319916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRUCE SCOTT DPM

Provider Business Mailing Address
First Line	:	1032 S 23RD ST APT 157
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-6645
Country	:	US
Telephone Number	:	515-230-1754
Fax Number	:	765-935-0745

Provider Business Practice Location Address
First Line	:	2100 E LAKE COOK RD
Second Line	:	SUITE 1100
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1999
Country	:	US
Telephone Number	:	800-317-0711
Fax Number	:	800-434-7113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	01/11/2012

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Directions to “ DR. DAVID BRUCE SCOTT DPM” Practice Location

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