MEDICARE: JAKUB JAN SKORUPA

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
1	122300000X	Dentist	019037197	IL

General Provider Information

NPI Number	:	1700752730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKUB JAN SKORUPA

Provider Business Mailing Address
First Line	:	8001 W LELAND AVE
Second Line	:
City	:	NORRIDGE
State	:	IL
Zip	:	60706-4450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	692 ESSINGTON RD UNIT A
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-4903
Country	:	US
Telephone Number	:	815-247-4911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	06/17/2026

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Directions to “ JAKUB JAN SKORUPA ” Practice Location

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