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NPI Code Detail

MEDICARE: LAUREN ELLEN SKALITZKY PA-C

MEDICARE: LAUREN ELLEN SKALITZKY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantIN PROCESSMA
2363AS0400XSurgical Physician Assistant085.006244IL

General Provider Information

NPI Number : 1043696180
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN ELLEN SKALITZKY PA-C
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 650
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2929
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 650
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2929
Country : US
Telephone Number : 630-802-6797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2015
Last Update Date : 11/06/2023

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Directions to “ LAUREN ELLEN SKALITZKY PA-C” Practice Location

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