Provider Demographics
NPI:1902800576
Name:SANDERS, SCOTT K (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 ROME DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4408
Mailing Address - Country:US
Mailing Address - Phone:765-807-7100
Mailing Address - Fax:765-870-7101
Practice Address - Street 1:3721 ROME DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4408
Practice Address - Country:US
Practice Address - Phone:765-807-7100
Practice Address - Fax:765-807-7101
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010456542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10019219OtherENCORE
IN200375760Medicaid
IN000000507081OtherANTHEM
IN200375760Medicaid
IN10019219OtherENCORE