Provider Demographics
NPI:1316202344
Name:SKAN LLC
Entity Type:Organization
Organization Name:SKAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:815-666-5748
Mailing Address - Street 1:3425 DREW AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2351
Mailing Address - Country:US
Mailing Address - Phone:815-570-5006
Mailing Address - Fax:815-846-1100
Practice Address - Street 1:3425 DREW AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2351
Practice Address - Country:US
Practice Address - Phone:815-570-5006
Practice Address - Fax:815-846-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL75-3247165261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation