Healthcare Provider Details

I. General information

NPI: 1790710283
Provider Name (Legal Business Name): JAN PAWEL SKOWRONSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 ROXBURY ROAD
ROCKFORD IL
61107-5059
US

IV. Provider business mailing address

PO BOX 6003
ROCKFORD IL
61126-6003
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-3000
  • Fax: 815-398-3041
Mailing address:
  • Phone: 815-398-3000
  • Fax: 815-391-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36112374
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number36112374
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number36112374
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number36112374
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number36112374
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number36112374
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: