Provider Demographics
NPI:1093005399
Name:GERSHAN, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:GERSHAN
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 1:446 E ONTARIO ST STE 7-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4418
Mailing Address - Country:US
Mailing Address - Phone:312-926-2323
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1000
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8709
Practice Address - Country:US
Practice Address - Phone:312-695-2198
Practice Address - Fax:312-695-6594
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361407122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry