Healthcare Provider Details

I. General information

NPI: 1609031293
Provider Name (Legal Business Name): SHARON MARIE SKALETZKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 11/27/2023
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST SUITE E352
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST SUITE E352
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8986
  • Fax: 269-341-6236
Mailing address:
  • Phone: 269-341-8986
  • Fax: 269-341-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME101720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: