Provider Demographics
NPI:1700297520
Name:PREVENTIVE HEALTH PARTNERS IL S.C.
Entity Type:Organization
Organization Name:PREVENTIVE HEALTH PARTNERS IL S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MACKAY
Authorized Official - Last Name:MORCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-757-8686
Mailing Address - Street 1:10 E. SCRANTON AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1582
Mailing Address - Country:US
Mailing Address - Phone:847-816-3434
Mailing Address - Fax:
Practice Address - Street 1:10 E SCRANTON AVE STE 303
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2561
Practice Address - Country:US
Practice Address - Phone:847-816-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36099609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty