Provider Demographics
NPI:1023465655
Name:KATHRYN SKOLARZ, M.D., S.C.
Entity type:Organization
Organization Name:KATHRYN SKOLARZ, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-505-6577
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 366
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-594-1410
Mailing Address - Fax:773-774-1402
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 366
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-594-1410
Practice Address - Fax:773-774-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114272945OtherNPI TYPE 1