Individual
DR. SCOTT EDWARD MIMMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1704 LAFAYETTE RD STE 5, CRAWFORDSVILLE, IN 47933
(765) 361-3011
(765) 362-5540
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01068514A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000781470
ANTHEM
IN
05
—
200986830
—
IN
Enumeration date
05/23/2008
Last updated
03/15/2021
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