Provider Demographics
NPI:1497771851
Name:SKOPEC, KATHRYN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARY
Last Name:SKOPEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:MIKKELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-688-7337
Mailing Address - Fax:319-688-7701
Practice Address - Street 1:2769 HEARTLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-688-7337
Practice Address - Fax:319-688-7701
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-31253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30343Medicare UPIN