Provider Demographics
NPI:1972535862
Name:SCOTT, TARA LONG (DPM)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LONG
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:29425 NORTHWESTERN HWY
Mailing Address - Street 2:STE 125
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1083
Mailing Address - Country:US
Mailing Address - Phone:248-557-6500
Mailing Address - Fax:248-557-2781
Practice Address - Street 1:29425 NORTHWESTERN HWY
Practice Address - Street 2:STE 125
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1083
Practice Address - Country:US
Practice Address - Phone:248-557-6500
Practice Address - Fax:248-557-2781
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MITS001844213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4842666Medicaid
MI16951OtherM CARE
MI5889627OtherAETNA
MI61783OtherOMNI CARE
MIP00292714OtherRAILROAD MEDICARE
MITS001844OtherBLUE CROSS BLUE CARE NET
MIU76095OtherHAP
MI4842666Medicaid
MI5889627OtherAETNA
MIU76095Medicare UPIN