MEDICARE: DR. SCOTT R HOMANN M.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	174400000X	Specialist	036-069323	IL
2	207RI0200X	Infectious Disease Physician	036069323	IL

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	:	1689674541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT R HOMANN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 78866
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53278-8866
Country	:	US
Telephone Number	:	779-696-7150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 CHARLES ST STE 404
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61104-2200
Country	:	US
Telephone Number	:	779-696-1890
Fax Number	:	779-696-5898

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/15/2021

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