Provider Demographics
NPI:1154307817
Name:SKIBNESS, LORIE A (MD)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:A
Last Name:SKIBNESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINEEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:612-371-1673
Practice Address - Street 1:2220 RIVERSIDE AVE S.
Practice Address - Street 2:MS31700A HEALTHPARTNERS RIVERSIDE CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:612-341-5000
Practice Address - Fax:612-371-1673
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34346207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN760205700Medicaid
070000695Medicare ID - Type Unspecified
E61491Medicare UPIN