Provider Demographics
NPI:1942249586
Name:SKIENDZIELEWSKI, JOHN ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:SKIENDZIELEWSKI
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 1:1518 LEGACY DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6039
Mailing Address - Country:US
Mailing Address - Phone:972-378-5347
Mailing Address - Fax:
Practice Address - Street 1:1518 LEGACY DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6039
Practice Address - Country:US
Practice Address - Phone:972-378-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8193207P00000X, 202K00000X
MDH0061705207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405516100Medicaid
MDI12327Medicare UPIN
MD584L-J354Medicare ID - Type Unspecified
TX335837YYC1Medicare UPIN