Provider Demographics
NPI:1164450227
Name:SKILES, MELVIN J (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:J
Last Name:SKILES
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-265-5211
Mailing Address - Fax:812-265-0570
Practice Address - Street 1:1 KINGS DAUGHTERS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3300
Practice Address - Country:US
Practice Address - Phone:812-265-5211
Practice Address - Fax:812-265-0570
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010257612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1128287OtherPASSPORT KY MEDICAID
IN200261710AMedicaid
KY64179930Medicaid
4322410OtherAETNA
IN000000107338OtherANTHEM BCBS
KY2437492000OtherPASSPORT ADVANTAGE
300128983OtherMEDICARE RAILROAD
KY64179930Medicaid
IN412840IIMedicare PIN
KY1128287OtherPASSPORT KY MEDICAID
B28855Medicare UPIN