Provider Demographics
NPI:1497787766
Name:SKAGGS, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:SKAGGS
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-891-8300
Mailing Address - Fax:502-891-8338
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25795207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100388550FMedicaid
IN100388550AMedicaid
KY1056155OtherPASSPORT PIN
KY000000693045OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY2433846000OtherPASSPORT ADVANTAGE PIN
KY000057080ROtherHUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY64257959Medicaid
KYP00893034OtherRAILROAD MEDICARE- CTS
KY000000044927OtherANTHEM PIN
KY64257959Medicaid
KY0780806Medicare PIN
KY000000044927OtherANTHEM PIN
KYP00893034OtherRAILROAD MEDICARE- CTS
KY000000693045OtherANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE
KYC69429Medicare UPIN
KY000057080ROtherHUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY1271820Medicare ID - Type Unspecified
KY0558409Medicare ID - Type Unspecified