Provider Demographics
NPI:1487269361
Name:WINKLE, SCOTT LAWRENCE JR (CPRM)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:WINKLE
Suffix:JR
Gender:M
Credentials:CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:133 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3350
Mailing Address - Country:US
Mailing Address - Phone:989-631-0241
Mailing Address - Fax:
Practice Address - Street 1:1019 CAMPUS DR RM 201
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2280
Practice Address - Country:US
Practice Address - Phone:231-591-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM-00526175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist