Provider Demographics
NPI:1740455484
Name:DR GERARD J SKROCKI DPM
Entity type:Organization
Organization Name:DR GERARD J SKROCKI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKROCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-254-2211
Mailing Address - Street 1:42370 VANDYKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-254-2211
Mailing Address - Fax:586-254-2297
Practice Address - Street 1:42370 VANDYKE
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-254-2211
Practice Address - Fax:586-254-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0744620001Medicare NSC