Provider Demographics
NPI:1629045000
Name:SKULEMOWSKI, PATRICK STANELY (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:STANELY
Last Name:SKULEMOWSKI
Suffix:
Gender:M
Credentials:DO
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 5395
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-5395
Mailing Address - Country:US
Mailing Address - Phone:956-554-9722
Mailing Address - Fax:956-554-9939
Practice Address - Street 1:3150 INTERNATIONAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3214
Practice Address - Country:US
Practice Address - Phone:956-554-9722
Practice Address - Fax:956-554-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6331207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096510502Medicaid
TX1629045000OtherINDIV. NPI
TX1629045000OtherINDIV. NPI
G77989Medicare UPIN