Provider Demographics
NPI:1568573764
Name:SKILLRUD, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:SKILLRUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:652 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1536
Mailing Address - Country:US
Mailing Address - Phone:309-266-8880
Mailing Address - Fax:309-266-8889
Practice Address - Street 1:652 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1536
Practice Address - Country:US
Practice Address - Phone:309-266-8880
Practice Address - Fax:309-266-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070507207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL005732063OtherBLUE CROSS BLUE SHIELD
IL005145OtherHEALTH ALLIANCE
IL209001Medicare PIN