Provider Demographics
NPI:1841211380
Name:SCHOLL, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SCHOLL
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 1:1401 EAST 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-9216
Mailing Address - Country:US
Mailing Address - Phone:815-539-7461
Mailing Address - Fax:815-538-5516
Practice Address - Street 1:1405 EAST 12TH STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-9216
Practice Address - Country:US
Practice Address - Phone:815-538-7200
Practice Address - Fax:815-539-1444
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068326Medicaid
L90838Medicare ID - Type Unspecified
D15455Medicare UPIN