Provider Demographics
NPI:1386618445
Name:SCOTT, MICHELE O (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:O
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:C-500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-439-7196
Mailing Address - Fax:602-439-7439
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:C-500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-439-7196
Practice Address - Fax:602-439-7439
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH49372Medicare UPIN
AZZ105156Medicare PIN