Healthcare Provider Details

I. General information

NPI: 1992021125
Provider Name (Legal Business Name): CAROLINE L SKOLNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST RM 440
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

1819 W POLK ST # MC733
CHICAGO IL
60612-4356
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7704
  • Fax:
Mailing address:
  • Phone: 312-996-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036133484
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036133484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: