Provider Demographics
NPI:1174505622
Name:SCOTT, HENRIQUE E (MD)
Entity Type:Individual
Prefix:
First Name:HENRIQUE
Middle Name:E
Last Name:SCOTT
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 1:9201 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2807
Mailing Address - Country:US
Mailing Address - Phone:219-836-9024
Mailing Address - Fax:219-836-0034
Practice Address - Street 1:801 W GLEN PARK AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2087
Practice Address - Country:US
Practice Address - Phone:219-924-3379
Practice Address - Fax:219-924-3788
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054305A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200327420Medicaid
IN197030AMedicare PIN
F86086Medicare UPIN