Provider Demographics
NPI:1083600944
Name:SKIBA, GRZEGORZ (MD)
Entity type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:
Last Name:SKIBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S BISCAYNE BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-4308
Mailing Address - Country:US
Mailing Address - Phone:305-428-7730
Mailing Address - Fax:786-558-5464
Practice Address - Street 1:925 NE 30TH TER STE 206
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:786-475-7703
Practice Address - Fax:855-490-4044
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22596207LP2900X
FLME126673207LP2900X
WAMD00048913207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8945755OtherCRIME VICTIMS
WA0226633OtherLABOR & INDUSTRIES
WA8505661Medicaid
WA8945755OtherCRIME VICTIMS