Basic Information
| Provider Information | |||||||||
| NPI: | 1235272394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOT | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 W SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489151927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173647200 | ||||||||
| FaxNumber: | 5173647201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 W SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489151927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173647200 | ||||||||
| FaxNumber: | 5173647201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301046186 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2000 | 01 | MI | CERTIFICATION IN HOSPICE | OTHER | 1983 | 01 | MI | MI MEDICAL LICENSE | OTHER | 1987 | 01 | MI | AMERICAN BOARD OF INTERNA | OTHER |