Healthcare Provider Details

I. General information

NPI: 1699260166
Provider Name (Legal Business Name): JOSEPH M SKOPEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CLINTON ST
MUSKEGON MI
49442-5502
US

IV. Provider business mailing address

1675 LEAHY ST STE 315A
MUSKEGON MI
49442-5543
US

V. Phone/Fax

Practice location:
  • Phone: 231-726-3511
  • Fax:
Mailing address:
  • Phone: 231-727-5244
  • Fax: 231-727-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036159500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: