Provider Demographics
NPI:1437158326
Name:SEYMOUR, SCOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:SEYMOUR
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 1:353 E BURLINGTON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2082
Mailing Address - Country:US
Mailing Address - Phone:708-442-0221
Mailing Address - Fax:708-442-5670
Practice Address - Street 1:353 E BURLINGTON ST
Practice Address - Street 2:STE 100
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2082
Practice Address - Country:US
Practice Address - Phone:708-442-0221
Practice Address - Fax:708-442-5670
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077172207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633451OtherBLUE CROSS BLUE SHIELD
ILP00061395OtherRAILROAD MEDICARE
IL036077172Medicaid
IL123175300OtherUS DEPARTMENT OF LABOR
ILK00598Medicare ID - Type Unspecified
ILP00061395OtherRAILROAD MEDICARE