Provider Demographics
NPI:1306898036
Name:DUEMLER, SCOTT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:DUEMLER
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 1:7740 BYRON CENTER AVE SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-6929
Mailing Address - Country:US
Mailing Address - Phone:616-217-5100
Mailing Address - Fax:616-217-5105
Practice Address - Street 1:7740 BYRON CENTER AVE SW
Practice Address - Street 2:SUITE 202
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-6929
Practice Address - Country:US
Practice Address - Phone:616-217-5100
Practice Address - Fax:616-217-5105
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4554974Medicaid
MI4877115Medicaid
MI3415591Medicaid
MI4179022Medicaid
MI4187964Medicaid
MIF07621Medicare UPIN
MI3415591Medicaid
MI4877115Medicaid
MI4554974Medicaid