Provider Demographics
NPI:1891784633
Name:VAN VALIN, SCOTT ERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ERWIN
Last Name:VAN VALIN
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 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC ORTHOPAEDIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-337-7339
Mailing Address - Fax:414-337-7337
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC ORTHOPAEDIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-337-7339
Practice Address - Fax:414-337-7337
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36464207X00000X, 2080S0010X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891784633Medicaid
WI736011990Medicare PIN
I28397Medicare UPIN
WI001201621Medicare PIN
WI680860735Medicare PIN