Provider Demographics
NPI:1215019203
Name:SKUBITZ, KEITH MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:MITCHELL
Last Name:SKUBITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-5411
Mailing Address - Fax:
Practice Address - Street 1:424 HARVARD STREET SE
Practice Address - Street 2:MASONIC CANCER CENTER, FIRST FLOOR, SUITE M100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23896207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10387Medicaid
MN36-00013OtherMEDICA PRIMARY
MN597099OtherARAZ
WI30713600Medicaid
MN2T180SKOtherBLUE CROSS BLUE SHIELD
SD7777470Medicaid
MN100796OtherUCARE
MN757873300Medicaid
MN36-00276OtherMEDICA CHOICE
MN1009310OtherPREFERRED ONE
MNHP22239OtherHEALTH PARTNERS
MN757873300Medicaid
MN597099OtherARAZ
MNHP22239OtherHEALTH PARTNERS