Basic Information
| Provider Information | |||||||||
| NPI: | 1245210210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKAR | ||||||||
| FirstName: | DUANE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1804 7TH ST W | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551162300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512277806 | ||||||||
| FaxNumber: | 6512566766 | ||||||||
| Practice Location | |||||||||
| Address1: | 1804 7TH ST W | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551162300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512277806 | ||||||||
| FaxNumber: | 6512566766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 30836 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1245210210 | 05 | MN | MEDICAID |