Provider Demographics
NPI:1275645541
Name:SKARDA, VICKI L (DO)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:SKARDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:KUBESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:204 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-9449
Mailing Address - Country:US
Mailing Address - Phone:715-483-3221
Mailing Address - Fax:
Practice Address - Street 1:204 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9449
Practice Address - Country:US
Practice Address - Phone:715-483-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN072J3KUOtherBLUE CROSS MN FACILITY
080176515OtherRAILROAD
MN072J4KUOtherBLUE CROSS MN PRO FEE
0107134OtherMEDICA
WI43494800Medicaid
HP33862OtherHEALTHPARTNERS
NA9031028480OtherPREFERREDONE
MN444251200Medicaid