Provider Demographics
NPI:1932286499
Name:SKYL PHYSICAL MEDICINE & RHEUMATOLOGY
Entity Type:Organization
Organization Name:SKYL PHYSICAL MEDICINE & RHEUMATOLOGY
Other - Org Name:SKYL SPORTS MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INKWANG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-240-7595
Mailing Address - Street 1:17000 HUBBARD DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4258
Mailing Address - Country:US
Mailing Address - Phone:313-240-7595
Mailing Address - Fax:313-240-7599
Practice Address - Street 1:17000 HUBBARD DR
Practice Address - Street 2:SUITE 800
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4258
Practice Address - Country:US
Practice Address - Phone:313-240-7595
Practice Address - Fax:313-240-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26153Medicare PIN