Provider Demographics
NPI:1437187630
Name:SCOTT, KENNETH M (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:SCOTT
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 1:2315 W 57TH STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6406
Mailing Address - Country:US
Mailing Address - Phone:605-336-3503
Mailing Address - Fax:605-336-6010
Practice Address - Street 1:2315 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5046
Practice Address - Country:US
Practice Address - Phone:605-336-3503
Practice Address - Fax:605-336-6010
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD5965207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6520490Medicaid
SD1437187630OtherAETNA
SD36376OtherSANFORD HEALTH PLAN
NE10024989000Medicaid
SD473L8SCOtherBLUE CROSS BLUE SHIELD OF MINNESOTA
SD4993557OtherWELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA
SD9214052OtherDAKOTACARE
SD721560818022OtherAMERICA'S PPO/ARAZ
SDHP3956OtherHEALTHPARTNERS
MNOT742SCOtherBLUE CROSS BLUE SHIELD OF MINNESOTA
SD1000817OtherMEDICA
SD6520490Medicaid