MEDICARE: MR. SCOTT DAVID ARNOLD

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1497917876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT DAVID ARNOLD

Provider Business Mailing Address
First Line	:	320 DEWEY AVE STE A
Second Line	:	NAVAL SPECIAL WARFARE PREPARATORY SCHOOL BLDG 322
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-2911
Country	:	US
Telephone Number	:	847-688-6201
Fax Number	:	847-688-6140

Provider Business Practice Location Address
First Line	:	320 DEWEY AVE STE A
Second Line	:	NAVAL SPECIAL WARFARE PREPARATORY SCHOOL BLDG 322
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-2911
Country	:	US
Telephone Number	:	847-688-6201
Fax Number	:	847-688-6140

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	04/15/2010

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