Provider Demographics
NPI:1184626673
Name:LOWRY, SCOTT R (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:LOWRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 GRAYMOOR LN
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1216
Mailing Address - Country:US
Mailing Address - Phone:708-417-3375
Mailing Address - Fax:
Practice Address - Street 1:9501 171ST ST STE Q
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487
Practice Address - Country:US
Practice Address - Phone:708-966-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062578Medicaid
IL08000120BMedicare PIN
ILD14680Medicare UPIN
ILK53157Medicare PIN
ILK25553Medicare PIN