Provider Demographics
NPI:1417911967
Name:SKIERKA, TRACI L (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:SKIERKA
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:PO BOX 665
Mailing Address - Street 2:513 N CHERRY ST
Mailing Address - City:SHELL ROCK
Mailing Address - State:IA
Mailing Address - Zip Code:50670
Mailing Address - Country:US
Mailing Address - Phone:319-885-6530
Mailing Address - Fax:319-885-6535
Practice Address - Street 1:513 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:SHELL ROCK
Practice Address - State:IA
Practice Address - Zip Code:50670
Practice Address - Country:US
Practice Address - Phone:319-885-6530
Practice Address - Fax:319-885-6535
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32705207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG88810Medicare UPIN