Healthcare Provider Details

I. General information

NPI: 1215557665
Provider Name (Legal Business Name): MATTHEW THOMAS BENJAMIN SKALAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD STE 225
NOVI MI
48375-1882
US

IV. Provider business mailing address

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES MI
48081-3203
US

V. Phone/Fax

Practice location:
  • Phone: 248-426-1300
  • Fax: 248-426-1311
Mailing address:
  • Phone: 586-771-4820
  • Fax: 586-771-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2025012429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: