Basic Information
Provider Information | |||||||||
NPI: | 1487648028 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHOLNIK | ||||||||
FirstName: | AARON | ||||||||
MiddleName: | P | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4602 DEPT | ||||||||
Address2: |   | ||||||||
City: | CAROL STREAM | ||||||||
State: | IL | ||||||||
PostalCode: | 601220021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9062253922 | ||||||||
FaxNumber: | 9062254527 | ||||||||
Practice Location | |||||||||
Address1: | 1414 W FAIR AVE | ||||||||
Address2: | SUITE 332 | ||||||||
City: | MARQUETTE | ||||||||
State: | MI | ||||||||
PostalCode: | 498552675 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9062253922 | ||||||||
FaxNumber: | 9062254527 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/09/2005 | ||||||||
LastUpdateDate: | 04/22/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 4301030366 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
ID | Type | State | Issuer | Description | 0330534 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 3145576 | 05 | MI |   | MEDICAID | P00228130 | 01 | MI | RAILROAD MEDICARE | OTHER |