Healthcare Provider Details

I. General information

NPI: 1124011887
Provider Name (Legal Business Name): SKOKIE VALLEY CT CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 GROSS POINT RD SUITE A
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

9600 GROSS POINT RD SUITE A
SKOKIE IL
60076-1214
US

V. Phone/Fax

Practice location:
  • Phone: 847-933-3856
  • Fax: 847-677-9625
Mailing address:
  • Phone: 847-933-3856
  • Fax: 847-677-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN M PFLAUMER
Title or Position: ACCOUNTS RECEIVABLE SUPERVISOR
Credential:
Phone: 847-933-3586