Basic Information
| Provider Information | |||||||||
| NPI: | 1033250428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKAU | ||||||||
| FirstName: | RANDELL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2809 OLIVE HWY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328161 | ||||||||
| FaxNumber: | 5305383270 | ||||||||
| Practice Location | |||||||||
| Address1: | 2809 OLIVE HWY | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328161 | ||||||||
| FaxNumber: | 5305383270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | TD-05-012 | ME | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 431740099 | 05 | ME | MEDICAID |