Blickensderfer, Scott Alan

Blickensderfer, Scott Alan is an individual health care provider with primary practice located at 6301 University Commons Ste 350, South Bend IN 46635-1571. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Blickensderfer, Scott Alan can be contacted via phone (574) 234-4100.

Contact Information

Primary practice address
6301 University Commons Ste 350 South Bend IN 46635-1571
Phone: (574) 234-4100
Fax: (574) 282-1739
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 02001398A Indiana

Profile Details

NPI number 1578568572
LBN Legal business name Blickensderfer, Scott Alan
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Mar 6th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578568572 NPPES
Other 0000000234054 ANTHEM
Other 264180V ANTHEM
MEDICAID 100093110 ANTHEM

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