Individual
DR. JEROME RUSCEAK SKELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1700
(574) 647-1993
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01049640A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
01049640A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200203460
—
IN
Enumeration date
11/30/2005
Last updated
12/18/2024
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