Healthcare Provider Details

I. General information

NPI: 1093810467
Provider Name (Legal Business Name): CRAIG L SKOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 S HOWELL AVE STE 400
OAK CREEK WI
53154-8337
US

IV. Provider business mailing address

8201 S HOWELL AVE STE 400
OAK CREEK WI
53154-8337
US

V. Phone/Fax

Practice location:
  • Phone: 414-570-1122
  • Fax:
Mailing address:
  • Phone: 414-570-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27804-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: