Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 36084477 | IL |
NPI | 1043284144 |
---|---|
Provider Name | Scott M Mercola |
First Address | River Forest, IL 60305 |
Second Address | River Forest, IL 60305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36084477 | (05) | IL |
G49832 | (02) |