Provider Demographics
NPI:1952473001
Name:DAVID M SKILLRUD MD LTD
Entity Type:Organization
Organization Name:DAVID M SKILLRUD MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-266-8880
Mailing Address - Street 1:652 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1536
Mailing Address - Country:US
Mailing Address - Phone:309-266-8880
Mailing Address - Fax:309-266-8889
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3592
Practice Address - Country:US
Practice Address - Phone:309-451-9500
Practice Address - Fax:309-266-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005732063OtherBLUE CROSS BLUE SHIELD
IL005145OtherHEALTH ALLIANCE
IL0005732063OtherBLUE CROSS BLUE SHIELD
IL209001Medicare PIN