Healthcare Provider Details

I. General information

NPI: 1063943850
Provider Name (Legal Business Name): TREVOR JOSEPH SKROBUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N GRAND AVE
FORT THOMAS KY
41075-1793
US

IV. Provider business mailing address

231 ALBERT SABIN WAY MSB 1654
CINCINNATI OH
45267-2827
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-3618
  • Fax: 859-572-2326
Mailing address:
  • Phone: 513-558-8114
  • Fax: 513-558-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01085206A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55056
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: