Healthcare Provider Details

I. General information

NPI: 1114272945
Provider Name (Legal Business Name): KATHRYN SKOLARZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE #366
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALCOTT AVE #366
CHICAGO IL
60631-3745
US

V. Phone/Fax

Practice location:
  • Phone: 773-594-1410
  • Fax: 773-774-1402
Mailing address:
  • Phone: 773-594-1410
  • Fax: 773-774-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036136435
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: