Healthcare Provider Details

I. General information

NPI: 1912952722
Provider Name (Legal Business Name): JOHN SKOSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 WAUKEGAN RD SUITE 200
MORTON GROVE IL
60053-2111
US

IV. Provider business mailing address

900 RAND RD STE 300 ATTN: RAQUEL LEON
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 847-375-3000
  • Fax:
Mailing address:
  • Phone: 847-324-3976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036-038417
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: