Provider Demographics
NPI:1639167125
Name:SCOTT, CAROLINE G M (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:G M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 TRAUTNER DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9596
Mailing Address - Country:US
Mailing Address - Phone:989-790-3697
Mailing Address - Fax:989-790-5035
Practice Address - Street 1:2429 TRAUTNER DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9596
Practice Address - Country:US
Practice Address - Phone:989-790-3697
Practice Address - Fax:989-790-5035
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI04751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4333436Medicaid
B46098Medicare UPIN
MI4333436Medicaid