Healthcare Provider Details

I. General information

NPI: 1174720452
Provider Name (Legal Business Name): LISA MARIE SKOWRON MAMS, BCO, BADO, CCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE SKOWRON MAMS, BCO, BADO, CCA

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23605 N HIGH RIDGE DR CHRYSALIS ANAPLASTOLOGY INC
LAKE ZURICH IL
60047-9048
US

IV. Provider business mailing address

23605 N HIGH RIDGE DR
LAKE ZURICH IL
60047-9048
US

V. Phone/Fax

Practice location:
  • Phone: 847-719-2984
  • Fax: 847-719-2984
Mailing address:
  • Phone: 847-719-2984
  • Fax: 847-719-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: