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General NPI Number Information
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NPI Number | 1568704443
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Entity Type | Organization
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Legal Business Name | SKYLINE PHYSICIANS LLC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1200 ROOSEVELT RD STE 140
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City | GLEN ELLYN
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State | IL
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Zip | 60137-7813
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Country | US
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Telephone | 708-307-2103
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 ROOSEVELT RD STE 140
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City | GLEN ELLYN
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State | IL
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Zip | 60137-7813
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Country | US
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Telephone | 708-307-2103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAFAI BUKHARI
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Credential | M.D
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Telephone | 708-307-2103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 036129282
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 036129282
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036129282
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RI0001X
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Taxonomy Name | Clinical & Laboratory Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036129282
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036129282
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036129282
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License Number State | IL
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