Provider Demographics
NPI:1285622373
Name:ESHOWSKY, SCOTT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:ESHOWSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:6913 N MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8039
Practice Address - Country:US
Practice Address - Phone:574-647-1500
Practice Address - Fax:574-647-2567
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052998A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200325710Medicaid
IN000000588533OtherBCBS E BLAIR WARNER
IN08090870OtherRR MEDICARE
IN000000492271OtherBCBS MEMORIAL WEIGHT LOSS
IN000000588533OtherBCBS E BLAIR WARNER
IN219570EMedicare PIN
IN162520MMMMedicare UPIN
IN236040NNNMedicare PIN
INH35681Medicare UPIN
IN236040155Medicare PIN