Provider Demographics
NPI:1063444966
Name:SCOTT, COLLEEN M (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22905 W MAIN ST
Mailing Address - Street 2:P.O.BOX 536
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-3247
Mailing Address - Country:US
Mailing Address - Phone:585-864-7380
Mailing Address - Fax:586-473-8129
Practice Address - Street 1:22905 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-3247
Practice Address - Country:US
Practice Address - Phone:586-473-8082
Practice Address - Fax:586-473-8129
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08-5501196-4OtherBCBS PIN
MI4865992Medicaid
MI2515930OtherUNITED HEALTHCARE
MI4961907Medicaid
MI700E012740OtherBCBSM GROUP NUMBER
MI700E031600OtherBCBS GROUP NUMBER
MI7852659OtherAETNA
MIN40170075Medicare PIN
MI0N40170Medicare PIN
MI7852659OtherAETNA
MII25481Medicare UPIN