Provider Demographics
NPI:1760790638
Name:SCOTT T. MONSON, M.D. P.C.
Entity Type:Organization
Organization Name:SCOTT T. MONSON, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-881-4510
Mailing Address - Street 1:20380 HARPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:58225-1643
Mailing Address - Country:US
Mailing Address - Phone:313-881-4510
Mailing Address - Fax:313-881-1177
Practice Address - Street 1:20380 HARPER AVENUE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:58225-1643
Practice Address - Country:US
Practice Address - Phone:313-881-4510
Practice Address - Fax:313-881-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040712207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1370033Medicaid
MI1370033Medicaid