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General NPI Number Information
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NPI Number | 1396987053
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Entity Type | Individual
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Provider Name | GLENN SKOW M.D., MPH, FAAFP
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Gender | Male
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 650 W TAYLOR ST
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City | VANDALIA
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State | IL
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Zip | 62471-1227
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Country | US
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Telephone | 618-283-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 825 NEW YORK DR STE 2
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City | VANDALIA
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State | IL
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Zip | 62471-1044
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Country | US
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Telephone | 618-283-5545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 258929
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036130323
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036130323
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License Number State | IL
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