Healthcare Provider Details

I. General information

NPI: 1114250875
Provider Name (Legal Business Name): SKOKIE FAMILY CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4726 OAKTON ST
SKOKIE IL
60076-3000
US

IV. Provider business mailing address

4726 OAKTON ST
SKOKIE IL
60076-3000
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-0455
  • Fax: 847-674-0466
Mailing address:
  • Phone: 847-674-0455
  • Fax: 847-674-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036119286
License Number StateIL

VIII. Authorized Official

Name: DR. DIMA HANNA
Title or Position: PHYSICIAN
Credential: MD
Phone: 847-778-6572