Provider Demographics
NPI:1083697528
Name:PLENSDORF, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:PLENSDORF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:G3245 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3615
Practice Address - Country:US
Practice Address - Phone:810-733-3650
Practice Address - Fax:810-733-9668
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI253047OtherMCLAREN HEALTH PLAN
MI253047OtherHEALTH ADVANTAGE NETWORK
MI4125157Medicaid
MI010B56026OtherCOMMUNITY BLUE PPO
MI010B56026OtherBLUE CHOICE
MI0802504591OtherBLUE CROSS BLUE SHIELD
MIC6555OtherMCARE
MIG28639OtherHAP
MI010B56026OtherBLUE CARE NETWORK
MI5954775OtherAETNA
MI010B56026OtherBLUE CROSS BLUE SHIELD
MI0985515OtherHEALTHPLUS
MIG28639OtherHEALTH NET FEDERAL SERVIC
MIG28639Medicare UPIN
MIOB56026098Medicare ID - Type Unspecified