Healthcare Provider Details

I. General information

NPI: 1902927254
Provider Name (Legal Business Name): KATHLEEN A SKOLI D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 E GRAND AVE SUITE 2
FOX LAKE IL
60020-1428
US

IV. Provider business mailing address

62 E GRAND AVE SUITE 2
FOX LAKE IL
60020-1428
US

V. Phone/Fax

Practice location:
  • Phone: 847-973-9050
  • Fax: 847-973-9051
Mailing address:
  • Phone: 847-973-9050
  • Fax: 847-973-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: