Healthcare Provider Details

I. General information

NPI: 1235573643
Provider Name (Legal Business Name): MARIYA ELLEN SKUBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST STE P302
DULUTH MN
55805-2201
US

IV. Provider business mailing address

920 E 1ST ST STE P302
DULUTH MN
55805-2201
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5555
  • Fax:
Mailing address:
  • Phone: 218-249-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60114
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: