Provider Demographics
NPI:1154370385
Name:SCOTT, MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7009
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-7009
Mailing Address - Country:US
Mailing Address - Phone:630-312-7865
Mailing Address - Fax:630-312-7902
Practice Address - Street 1:7234 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2269
Practice Address - Country:US
Practice Address - Phone:708-447-1177
Practice Address - Fax:708-447-1286
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36088149207R00000X
FLFO751W208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004227400Medicaid
IL1356386809OtherGROUP NPI
IL1861420846OtherGROUP NPI
IL400480OtherGROUP MEDICARE NUMBER
ILCN4921OtherRR MEDICARE NUMBER
ILDA1490OtherRR MEDICARE
IL1356386809OtherGROUP NPI
FL004227400Medicaid
ILK26827Medicare PIN
ILG24048Medicare UPIN