Provider Demographics
NPI:1568437937
Name:SPOTT, JOSEPH PHILLIP (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILLIP
Last Name:SPOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9768
Mailing Address - Country:US
Mailing Address - Phone:219-558-8068
Mailing Address - Fax:219-558-8149
Practice Address - Street 1:4320 FIR ST
Practice Address - Street 2:SUITE 417
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3052
Practice Address - Country:US
Practice Address - Phone:219-397-8648
Practice Address - Fax:219-397-8653
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001917A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200184170Medicaid
IN000000373304OtherANTHEM
IL0361058461Medicaid
IL90001235OtherBCBS
INN275934OtherHARMONY
IN7538064OtherAETNA
IN275934OtherWELLCARE
IN6582857OtherCIGNA
INPOO222849OtherRR MEDICARE
IL90001235OtherBCBS
IN275934OtherWELLCARE