SCOTT M. DETLOFF (NPI# 1639651060) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639651060 |
| Entity Type | Individual |
| Full Name | SCOTT M. DETLOFF |
| Credential | PA-C |
| Practice Address |
415 E Congress Pkwy Ste A Crystal Lake IL 60014-6248 |
| Practice Telephone | 8153567494 |
| Practice Fax Number | 8153567541 |
| Mailing Telephone | 8153567494 |
| Mailing Fax Number | 8153567541 |
| Enumeration Date | 2018-09-01 |
| Last Update Date | 2018-11-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085-006832 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 415-a E. Congress Parkway #1s, Crystal Lake, IL 60014 | 8337067846 |
| Street Address |
415 E CONGRESS PKWY STE A |
| City | CRYSTAL LAKE |
| State | IL |
| Zip Code | 60014-6248 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992871347 | Marko F Krpan | Orthopaedic Surgery | 415 E Congress Pkwy Ste A, Crystal Lake, IL 60014-6248 | 2006-11-28 |
| 1972814267 | Krishanthi Dilrukshi Seneviratne | Family Medicine | 415 E Congress Pkwy Ste A, Crystal Lake, IL 60014-6248 | 2010-07-01 |
| 1174790463 | James Anthony Krcik | Orthopaedic Surgery | 415 E Congress Pkwy Ste A, Crystal Lake, IL 60014-6248 | 2008-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497394720 | Lorelei Mariano | Physical Therapist | 350 E Congress Parkway Ste A, Crystal Lake, IL 60014 | 2020-01-03 |
| 1396227070 | Behavioral Services for Autism, Inc | Behavioral Analyst | 1095 Pingree Road, Suite 204, Crystal Lake, IL 60014 | 2018-08-30 |
| 1831635564 | Isis Mendoza-garnica | Counselor | 6803 Rose Ave, Crystal Lake, IL 60014 | 2017-01-19 |
| 1134664402 | Derick Dermatology, LLC | Non-Pharmacy Dispensing Site | 525 E Congress Parkway, Suite 200, Crystal Lake, IL 60014 | 2016-12-22 |
| 1306394051 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 177 W Virginia Street, Crystal Lake, IL 60014 | 2016-09-12 |
| 1124492830 | Align Spine & Orthopaedics | Durable Medical Equipment & Medical Supplies | 60 B West Terra Cotta Ave, #265, Crystal Lake, IL 60014 | 2015-11-18 |
| 1558747428 | Shabana Nawaz | Optometrist | 4777 Northwest Highway, Crystal Lake, IL 60014 | 2015-08-03 |
| 1548649205 | Daniel Okon | Social Worker | 304 Charllote Ave, Crystal Lake, IL 60014 | 2015-05-27 |
| 1154729838 | Crystal Lake Center for Chronic Pain Sc | Nurse Practitioner | 1 South Northwest Highway, Crystal Lake, IL 60014 | 2014-12-12 |
| 1558763581 | Brooke Nicole Grandt | Occupational Therapist | 394 Heisler Ct, Crystal Lake, IL 60014 | 2014-09-22 |
| Find all providers in zip 60014 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497295125 | Alexander J Hembrey | Physician Assistant | 420 N Il Route 31, Crystal Lake, IL 60012 | 2017-02-28 |
| 1316486459 | Nicole M Trittschuh | Physician Assistant | 420 N Il Route 31, Crystal Lake, IL 60012 | 2017-02-22 |
| 1942747480 | Christopher L Ballinger | Physician Assistant | 420 N. Il Route 31, Crystal Lake, IL 60012 | 2017-01-23 |
| 1548519986 | Stephanie H Goede | Physician Assistant | 420 N Il Route 31, Crystal Lake, IL 60012 | 2012-08-30 |
| 1902092109 | Jeremy A Houtakker | Physician Assistant | 750 E Terra Cotta Ave, Suite C, Crystal Lake, IL 60014-3621 | 2007-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
| Find all providers with the same taxonomy | ||||
| City | CRYSTAL LAKE |
| Zip Code | 60014 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.