Individual
SCOT A WILFONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1475 W GRAND AVE, PORT WASHINGTON, WI 53074
(262) 268-5100
(262) 268-5118
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29688
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31556500
—
WI
01
—
P00774641
RR MEDICARE
WI
Enumeration date
08/24/2006
Last updated
12/27/2023
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