Healthcare Provider Details

I. General information

NPI: 1497558076
Provider Name (Legal Business Name): AARON LOWELL SACKSCHEWSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/16/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 BALLARD RD FL 2
PARK RIDGE IL
60068-1005
US

IV. Provider business mailing address

1775 BALLARD RD FL 2
PARK RIDGE IL
60068-1005
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-6020
  • Fax: 847-318-2341
Mailing address:
  • Phone: 847-318-6020
  • Fax: 847-318-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.086028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: