Provider Demographics
NPI:1598731069
Name:ESKILDSEN, WALTER KARL (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:KARL
Last Name:ESKILDSEN
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 1:1401 EAST H STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3432
Mailing Address - Country:US
Mailing Address - Phone:308-345-7878
Mailing Address - Fax:308-345-7879
Practice Address - Street 1:1401 EAST H STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3432
Practice Address - Country:US
Practice Address - Phone:308-345-7878
Practice Address - Fax:308-345-7879
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20429208600000X
KS0427377208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91182588213Medicaid
KS053348ESMedicare ID - Type Unspecified
NE268945ESMedicare ID - Type Unspecified
G66680Medicare UPIN