Provider Demographics
NPI:1407940166
Name:FELDMAN, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FELDMAN
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 1:1565 MAPLE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4371
Mailing Address - Country:US
Mailing Address - Phone:847-246-4783
Mailing Address - Fax:
Practice Address - Street 1:820 DAVIS ST
Practice Address - Street 2:SUITE # 450
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4431
Practice Address - Country:US
Practice Address - Phone:847-328-2404
Practice Address - Fax:847-328-1295
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360955872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095587Medicaid
IL1619067OtherBCBS GROUP NUMBER