1821041740 NPI number — MICHEL W SKAF M.D.

Table of content: MICHEL W SKAF M.D. (NPI 1821041740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821041740 NPI number — MICHEL W SKAF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKAF
Provider First Name:
MICHEL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821041740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428S DURBIN ST 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-337-4283
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428S DURBIN ST 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-337-4284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  7159A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20373 . This is a "BCBS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: P00351461 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 121557400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313774 . This is a "BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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