Provider Demographics
NPI:1447216965
Name:EHMEN, SCOTT HARLAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:HARLAN
Last Name:EHMEN
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:P.O. BOX 110
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580
Mailing Address - Country:US
Mailing Address - Phone:574-267-3200
Mailing Address - Fax:
Practice Address - Street 1:1500 PROVIDENT DR STE A
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3297
Practice Address - Country:US
Practice Address - Phone:574-372-7637
Practice Address - Fax:574-372-7689
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054904A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200496380Medicaid
D94694Medicare UPIN
187170DDMedicare PIN
453220OMedicare PIN