Provider Demographics
NPI:1992737589
Name:SCARLETT, JEREMY ASHTON (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ASHTON
Last Name:SCARLETT
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:DEPT CH 17057
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-7057
Mailing Address - Country:US
Mailing Address - Phone:920-204-6758
Mailing Address - Fax:888-720-0495
Practice Address - Street 1:2124 KOHLER MEMORIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3174
Practice Address - Country:US
Practice Address - Phone:920-204-6758
Practice Address - Fax:888-720-0495
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51385-020207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35113200Medicaid
MO201011103Medicaid
I59391Medicare UPIN