Provider Demographics
NPI:1831135102
Name:HART, AVERY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:SCOTT
Last Name:HART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1285 HARTREY AVE
Mailing Address - Street 2:ERIE EVANSTON/SKOKIE HEALTH CENTER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1056
Mailing Address - Country:US
Mailing Address - Phone:847-666-3494
Mailing Address - Fax:847-868-8964
Practice Address - Street 1:1285 HARTREY AVE
Practice Address - Street 2:ERIE EVANSTON/SKOKIE HEALTH CENTER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1056
Practice Address - Country:US
Practice Address - Phone:847-666-3494
Practice Address - Fax:847-868-8964
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036078737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363088628Medicaid