Provider Demographics
NPI:1437214780
Name:SKOWRON, RALPH D (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:D
Last Name:SKOWRON
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:N2331 GREENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-8714
Mailing Address - Country:US
Mailing Address - Phone:920-779-9840
Mailing Address - Fax:920-779-9845
Practice Address - Street 1:402 WEST LAKE ST.
Practice Address - Street 2:MOUNDVIEW MEMORIAL HOSPITAL
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934
Practice Address - Country:US
Practice Address - Phone:608-339-8357
Practice Address - Fax:608-339-8359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32915207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31788900Medicaid
WI0073Medicare ID - Type Unspecified
WI31788900Medicaid