Individual
SCOTT DETLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
(815) 337-4793
Mailing address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
(815) 337-4793
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006832
IL
363AS0400X
Surgical Physician Assistant
085-006832
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085006832
STATE LICENSE
IL
Enumeration date
09/01/2018
Last updated
03/20/2026
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