Provider Demographics
NPI:1376553875
Name:ROBERTSON, SCOTT DUNCAN (DO)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DUNCAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5201 S WILLOW SPRINGS ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6537
Mailing Address - Country:US
Mailing Address - Phone:708-482-8088
Mailing Address - Fax:708-482-9034
Practice Address - Street 1:5201 S WILLOW SPRINGS ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-482-8088
Practice Address - Fax:708-482-9034
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094520Medicaid
IL036094520Medicaid
ILG62208Medicare UPIN