Individual
ALEXANDER SKAVYSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 JOHN R WOODEN DR, SUITE 201, MARTINSVILLE, IN 46151-1863
(765) 342-5415
(765) 342-3415
Mailing address
100 E MILLER DR APT 87, BLOOMINGTON, IN 47401-6572
(765) 343-2253
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01062091A
IN
208600000X
Surgery Physician
042-0012180
VT
208600000X
Surgery Physician
MD2010-0754
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104827633
GROUP NPI NUMBER
IN
01
—
200377200
GROUP MEDICAID
IN
05
—
200823150
—
IN
Enumeration date
07/17/2006
Last updated
05/18/2011
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