Provider Demographics
NPI:1790217297
Name:SKIBBA, KATHRYN ELIZABETH HALLBERG (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH HALLBERG
Last Name:SKIBBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5455
Mailing Address - Fax:515-643-6459
Practice Address - Street 1:411 LAUREL ST STE 2225
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3002
Practice Address - Country:US
Practice Address - Phone:515-643-5455
Practice Address - Fax:515-643-6459
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-514992086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program