Provider Demographics
NPI:1629079462
Name:ZAHNER, SCOTT L (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:ZAHNER
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 1:908 N ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3625
Mailing Address - Country:US
Mailing Address - Phone:630-884-5913
Mailing Address - Fax:630-455-1759
Practice Address - Street 1:908 N ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3625
Practice Address - Country:US
Practice Address - Phone:630-884-5913
Practice Address - Fax:630-455-1759
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-10-26
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IL036082742207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL545250Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILF25260Medicare UPIN
ILL71053Medicare PIN