Provider Demographics
NPI:1558563213
Name:ASSELMEIER, SCOTT GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GLEN
Last Name:ASSELMEIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:466 PENNSYLVANIA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4458
Mailing Address - Country:US
Mailing Address - Phone:313-570-1889
Mailing Address - Fax:
Practice Address - Street 1:450 W HIGHWAY 22
Practice Address - Street 2:DEPT OF RADIOLOGY
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1919
Practice Address - Country:US
Practice Address - Phone:312-563-4270
Practice Address - Fax:312-563-4280
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1157652085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-115765Medicaid
IL036-115765Medicaid