Provider Demographics
NPI:1376553875
Name:ROBERTSON, SCOTT DUNCAN (DO)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DUNCAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 WILLOW SPRINGS RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6506
Mailing Address - Country:US
Mailing Address - Phone:708-929-6099
Mailing Address - Fax:708-929-6169
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 180
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6506
Practice Address - Country:US
Practice Address - Phone:708-929-6099
Practice Address - Fax:708-929-6169
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094520Medicaid
IL036094520Medicaid
ILG62208Medicare UPIN