Provider Demographics
NPI:1609866433
Name:BORNSTEIN, SCOTT M (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:BORNSTEIN
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 1:9630 KENTON AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1216
Mailing Address - Country:US
Mailing Address - Phone:847-677-1631
Mailing Address - Fax:847-677-1406
Practice Address - Street 1:9630 KENTON AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1216
Practice Address - Country:US
Practice Address - Phone:847-677-1631
Practice Address - Fax:847-677-1406
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL990004123OtherRAILROAD MEDICARE
ILL77404Medicare PIN
ILG32260Medicare UPIN