Provider Demographics
NPI:1942282223
Name:SONG, SCOTT I (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:I
Last Name:SONG
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 1:6 E PHILLIP RD
Mailing Address - Street 2:STE 1105
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1700
Mailing Address - Country:US
Mailing Address - Phone:847-362-0691
Mailing Address - Fax:847-362-0694
Practice Address - Street 1:6 E PHILLIP RD
Practice Address - Street 2:STE 1105
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1700
Practice Address - Country:US
Practice Address - Phone:847-362-0691
Practice Address - Fax:847-362-0694
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603499OtherBCBS
ILL023777OtherCHAMPUS
ILL023777OtherCHAMPUS
IL927492Medicare ID - Type Unspecified