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Contact Information

SCOTT W EATHORNE, MD
30055 NORTHWESTERN HWY
#30
FARMINGTON HILLS, MI48334-3230
 Phone: 248-865-4030
 Fax: 248-426-7335
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for SCOTT W EATHORNE · (Male)

NPI Number 1760480974
Status Active
Credentials MD
Entity Individual
Enumeration date 07/12/2005
Last updated 01/25/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 4301055302
  • MI License # 4301056302
  • MI Medicaid 297537810
Hospital affiliation(s)
  • PROVIDENCE HOSPITAL AND MEDICAL CENTERS - (Acute Care)
    16001 W NINE MILE RD
    SOUTHFIELD, MI 48075
  • ST JOHN HOSPITAL AND MEDICAL CENTER - (Acute Care)
    22101 MOROSS RD
    DETROIT, MI 48236
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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