Healthcare Provider Details

I. General information

NPI: 1528704749
Provider Name (Legal Business Name): LINDSEY ALEXANDRA SKOLNIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY ALEXANDRA MOHNEY DO

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OLD CENTRE RD
PORTAGE MI
49024-4883
US

IV. Provider business mailing address

3000 OLD CENTRE RD
PORTAGE MI
49024-4883
US

V. Phone/Fax

Practice location:
  • Phone: 269-321-7546
  • Fax: 269-321-1705
Mailing address:
  • Phone: 269-321-7546
  • Fax: 269-321-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5101029558
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: