Healthcare Provider Details

I. General information

NPI: 1063054013
Provider Name (Legal Business Name): TIMOTHY C SKALITZKY NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N WAUKEGAN RD
NORTH CHICAGO IL
60064-1802
US

IV. Provider business mailing address

1 N WAUKEGAN RD
NORTH CHICAGO IL
60064-1802
US

V. Phone/Fax

Practice location:
  • Phone: 847-936-5800
  • Fax:
Mailing address:
  • Phone: 847-936-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.024424
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9435
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: