Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 2003 | MO |
Y | 208800000X | Urologist | 4301092219 | MI |
NPI | 1063531457 |
---|---|
Provider Name | Dr. Ted Albert Skolarus |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 23/02/2012 |