Provider Demographics
NPI:1255384442
Name:SCOTT, ANDREW JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HUEHL RD
Mailing Address - Street 2:#13
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2319
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:847-504-5015
Practice Address - Street 1:425 HUEHL RD
Practice Address - Street 2:#13
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000951A213E00000X
KY00329213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200425400AMedicaid
0732240001OtherDMERC # WITH PPG
KY7100246530Medicaid
KYP01250511OtherRAILROAD MEDICARE
IN480035123Medicare PIN
U92998Medicare UPIN
IN200425400AMedicaid
0732240001OtherDMERC # WITH PPG