Provider Demographics
NPI:1417935057
Name:MEYER, SCOTT J (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 COMPASS RD STE C&D
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1610
Mailing Address - Country:US
Mailing Address - Phone:847-998-0010
Mailing Address - Fax:847-998-1171
Practice Address - Street 1:2550 COMPASS RD STE C&D
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1610
Practice Address - Country:US
Practice Address - Phone:847-998-0010
Practice Address - Fax:847-998-1171
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071084Medicaid
C43372Medicare UPIN
IL036071084Medicaid