MEDICARE: SCOTT MITCHEL KAMILAR PH.D.

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	103TC0700X	Clinical Psychologist	LP2868	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174571384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MITCHEL KAMILAR PH.D.

Provider Business Mailing Address
First Line	:	8085 WAYZATA BLVD STE 216
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55426-1459
Country	:	US
Telephone Number	:	612-296-7942
Fax Number	:	763-231-1704

Provider Business Practice Location Address
First Line	:	1409 WILLOW ST
Second Line	:	SUITE 300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2269
Country	:	US
Telephone Number	:	612-870-1242
Fax Number	:	612-870-8077

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/31/2017

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