Provider Demographics
NPI:1891349445
Name:SCOTT, KEM E
Entity Type:Individual
Prefix:
First Name:KEM
Middle Name:E
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3102
Mailing Address - Country:US
Mailing Address - Phone:317-658-3276
Mailing Address - Fax:317-820-3535
Practice Address - Street 1:3031 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3102
Practice Address - Country:US
Practice Address - Phone:317-658-3276
Practice Address - Fax:317-820-3535
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty