Provider Demographics
NPI:1508803776
Name:CIECHNA, SCOTT P (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:CIECHNA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25259 S REED ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-6003
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:27240 W SAXONY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-1415
Practice Address - Country:US
Practice Address - Phone:815-467-1518
Practice Address - Fax:815-467-7419
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36-111123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI20791Medicare UPIN