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General NPI Number Information
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NPI Number | 1043696180
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Entity Type | Individual
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Provider Name | LAUREN ELLEN SKALITZKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST STE 650
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City | CHICAGO
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State | IL
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Zip | 60611-2929
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Country | US
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Telephone | 630-802-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 676 N SAINT CLAIR ST STE 650
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City | CHICAGO
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State | IL
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Zip | 60611-2929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | IN PROCESS
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085.006244
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License Number State | IL
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