Healthcare Provider Details

I. General information

NPI: 1407217920
Provider Name (Legal Business Name): SKYLER KING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CALIFORNIA RD
ELKHART IN
46514-1228
US

IV. Provider business mailing address

2310 CALIFORNIA RD STE A
ELKHART IN
46514-1228
US

V. Phone/Fax

Practice location:
  • Phone: 574-264-0791
  • Fax:
Mailing address:
  • Phone: 574-264-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02006705A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: