Provider Demographics
NPI:1760446595
Name:SKIBA, TERESA G (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:G
Last Name:SKIBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:MR 11326
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-7560
Mailing Address - Fax:612-863-3809
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:MR 11326
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-7560
Practice Address - Fax:612-863-3809
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN39227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN138219500Medicaid
H04738Medicare UPIN
MN138219500Medicaid