MEDICARE: MS. ALLISON KELLY SKAE MHS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant		IL

General Provider Information

NPI Number	:	1972540771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON KELLY SKAE MHS, PA-C

Provider Business Mailing Address
First Line	:	6 E PHILLIP RD
Second Line	:	SUITE 1104
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1700
Country	:	US
Telephone Number	:	847-968-2300
Fax Number	:	847-968-2380

Provider Business Practice Location Address
First Line	:	6 E PHILLIP RD
Second Line	:	SUITE 1104
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1700
Country	:	US
Telephone Number	:	847-968-2300
Fax Number	:	847-968-2380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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