Healthcare Provider Details

I. General information

NPI: 1457768798
Provider Name (Legal Business Name): MARTIN SKOKAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 N CLIO RD
MOUNT MORRIS MI
48458-8261
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 888-218-4045
  • Fax: 810-249-4230
Mailing address:
  • Phone: 810-424-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: