Provider Demographics
NPI:1194774356
Name:SKOLNICK, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:SKOLNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-27590207RC0000X, 207RC0001X
MO100845207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1021033OtherMEDICARE - CUSHING
KS100333340GMedicaid
MO203854005Medicaid
KS100333340FMedicaid
KSP00842644OtherRAILROAD MEDICARE
KS100333340DMedicaid
MOP00836134OtherRAILROAD MEDICARE
KS100333340AMedicaid
MOP00836134OtherRAILROAD MEDICARE
G21592Medicare UPIN
KS100333340DMedicaid
KS100333340FMedicaid
KSKA1021033OtherMEDICARE - CUSHING