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General NPI Number Information
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NPI Number | 1316202344
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Entity Type | Organization
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Legal Business Name | SKAN LLC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 3425 DREW AVENUE SUITE A
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City | SANDWICH
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State | IL
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Zip | 60548-2351
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Country | US
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Telephone | 815-570-5006
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Fax | 815-846-1100
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Provider Business Mailing Address
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Address Line | 3425 DREW AVENUE SUITE A
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City | SANDWICH
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State | IL
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Zip | 60548-2351
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Country | US
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Telephone | 815-570-5006
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Fax | 815-846-1100
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Authorized Official
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Title or Position | DIRECTOR
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Name | KEVIN A KHATER
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Credential | MD, PHD
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Telephone | 815-666-5748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | 75-3247165
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License Number State | IL
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