Healthcare Provider Details

I. General information

NPI: 1225760176
Provider Name (Legal Business Name): EVAN PETER SKWARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

1301 W 18TH ST
SIOUX FALLS SD
57105-0401
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-2253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351050211
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: