Provider Demographics
NPI:1437572831
Name:PATHFINDER MEDICAL GROUP
Entity Type:Organization
Organization Name:PATHFINDER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-757-8686
Mailing Address - Street 1:191 E DEERPATH STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1900
Mailing Address - Country:US
Mailing Address - Phone:847-686-7284
Mailing Address - Fax:
Practice Address - Street 1:216 MILWAUKEE ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202
Practice Address - Country:US
Practice Address - Phone:262-240-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35906-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty