Healthcare Provider Details

I. General information

NPI: 1497771851
Provider Name (Legal Business Name): KATHRYN MARY SKOPEC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MARY MIKKELSEN

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 HEARTLAND DR STE 100
CORALVILLE IA
52241-2732
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-688-7337
  • Fax: 319-688-7701
Mailing address:
  • Phone: 319-688-7337
  • Fax: 319-688-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-31253
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: