Provider Demographics
NPI:1033140728
Name:MCPHILIMY, SCOTT A (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:MCPHILIMY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7470 BROCKWAY RD
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3458
Mailing Address - Country:US
Mailing Address - Phone:810-387-9355
Mailing Address - Fax:810-387-9400
Practice Address - Street 1:7470 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:MI
Practice Address - Zip Code:48097-3458
Practice Address - Country:US
Practice Address - Phone:810-387-9355
Practice Address - Fax:810-387-9400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4744039Medicaid
MIG61736Medicare UPIN