Provider Demographics
NPI:1124040266
Name:SKYIEPAL, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SKYIEPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 N HIGHWAY 77
Mailing Address - Street 2:STE 501-C #239
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1977
Mailing Address - Country:US
Mailing Address - Phone:888-558-5756
Mailing Address - Fax:888-558-5754
Practice Address - Street 1:14860 MONTFORT DR STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6873
Practice Address - Country:US
Practice Address - Phone:469-431-5656
Practice Address - Fax:877-658-8663
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1570208600000X, 208D00000X
WI2334208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046230104Medicaid
TX046230106Medicaid
WI100217995Medicaid
TX046230105Medicaid
TX8J3195Medicare ID - Type Unspecified
TX046230104Medicaid
TX8L2354Medicare PIN
TX8L2352Medicare PIN
TX8G1942Medicare ID - Type Unspecified
TX046230105Medicaid