Provider Demographics
NPI:1558460485
Name:SKUGOR, BLAZENKA (MD)
Entity Type:Individual
Prefix:
First Name:BLAZENKA
Middle Name:
Last Name:SKUGOR
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-349-1100
Mailing Address - Fax:440-349-8160
Practice Address - Street 1:33001 SOLON RD STE 202
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2864
Practice Address - Country:US
Practice Address - Phone:440-349-1100
Practice Address - Fax:440-349-8160
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2532978Medicaid
OH4148681Medicare PIN