Provider Demographics
NPI:1669463436
Name:MCLAIN, SCOTT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5850 6TH STREET FRONTAGE RD E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5162
Mailing Address - Country:US
Mailing Address - Phone:217-529-5046
Mailing Address - Fax:217-529-6154
Practice Address - Street 1:1701 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-662-5361
Practice Address - Fax:309-663-5742
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007006527207R00000X
IL036104057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH33206Medicare UPIN