Provider Demographics
NPI:1053361121
Name:SKAREDOFF, MICHAEL N (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:SKAREDOFF
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 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5249 E TERRACE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8339
Practice Address - Country:US
Practice Address - Phone:608-263-9550
Practice Address - Fax:608-263-0135
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33327207L00000X, 207LP2900X
IL036-074516207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-074516Medicaid
A61638Medicare UPIN
WI000132440Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IAP00477130Medicare PIN