Provider Demographics
NPI:1497774137
Name:BANDEL, SCOT W (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:W
Last Name:BANDEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4311
Mailing Address - Country:US
Mailing Address - Phone:308-382-9266
Mailing Address - Fax:308-382-5290
Practice Address - Street 1:729 N CUSTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4311
Practice Address - Country:US
Practice Address - Phone:308-382-9266
Practice Address - Fax:308-382-5290
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE307213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026091400Medicaid
NE10026091400Medicaid