MEDICARE: MS. CARLY LYNN SKAMRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	60089-20	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036118437	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275670275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLY LYNN SKAMRA M.D.

Provider Business Mailing Address
First Line	:	601 N BARKER RD
Second Line	:	SUITE 110
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5929
Country	:	US
Telephone Number	:	262-785-1964
Fax Number	:	262-785-0610

Provider Business Practice Location Address
First Line	:	601 N BARKER RD
Second Line	:	SUITE 110
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5929
Country	:	US
Telephone Number	:	262-785-1964
Fax Number	:	262-785-0610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/22/2013

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