Provider Demographics
NPI:1154410124
Name:WILBER, SCOTT SAXTON (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:SAXTON
Last Name:WILBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18558 WESTMORE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3250
Mailing Address - Country:US
Mailing Address - Phone:248-478-4271
Mailing Address - Fax:248-478-4271
Practice Address - Street 1:18558 WESTMORE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3250
Practice Address - Country:US
Practice Address - Phone:248-478-4271
Practice Address - Fax:248-478-4271
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002114213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist