Provider Demographics
NPI:1083618417
Name:NEELEY, SCOTT PORTER
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PORTER
Last Name:NEELEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6158
Mailing Address - Country:US
Mailing Address - Phone:773-935-5556
Mailing Address - Fax:773-935-2724
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:STE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6158
Practice Address - Country:US
Practice Address - Phone:773-935-5556
Practice Address - Fax:773-935-2724
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36082721207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36082721Medicaid
ILL80065Medicare ID - Type Unspecified
ILK02322Medicare PIN
IL36082721Medicaid