Provider Demographics
NPI:1912967381
Name:GIAIMO, SCOTT JASON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JASON
Last Name:GIAIMO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 KIRTS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4899
Mailing Address - Country:US
Mailing Address - Phone:248-528-1981
Mailing Address - Fax:248-528-2183
Practice Address - Street 1:110 POLARIS PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8026
Practice Address - Country:US
Practice Address - Phone:614-895-7280
Practice Address - Fax:614-895-8826
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003338213E00000X
MI5901001812213E00000X
PASC006165213E00000X
KY00375213E00000X
NY006416-1213E00000X
IN07001142A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424906Medicaid
MIP00705211OtherMEDICARE - RAILROAD
MI1912967381Medicaid
MI48-0-F3-8162-0OtherBCBS
KS201134250AMedicaid
OH311624470039OtherCARESOURCE
OH5919713OtherAETNA
U68124Medicare UPIN
OH5919713OtherAETNA
MI48-0-F3-8162-0OtherBCBS
KYK221291Medicare PIN
OH311624470039OtherCARESOURCE
MI1912967381Medicaid
OHG14106049Medicare PIN