Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301056424 | MI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 67151 | WI |
NPI | 1124019252 |
---|---|
Provider Name | Laurence P Skendzel |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 16/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080045678 | RAILROAD MEDICARE (01) | MI |
2946385 | (05) | MI |
F56494 | (02) |